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Roberts A, Grafton G, Powell AD, Brock K, Chen C, Xie D, Huang J, Liu S, Cooper AJ, Brady CA, Qureshi O, Stamataki Z, Manning DD, Moore NA, Sargent BJ, Guzzo PR, Barnes NM. CSTI-300 (SMP-100); a Novel 5-HT 3 Receptor Partial Agonist with Potential to Treat Patients with Irritable Bowel Syndrome or Carcinoid Syndrome. J Pharmacol Exp Ther 2020; 373:122-134. [PMID: 32102919 DOI: 10.1124/jpet.119.261008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 01/24/2020] [Indexed: 12/12/2022] Open
Abstract
The 5-hydroxytryptamine (5-HT) (serotonin) 5-HT3 receptor represents a clinical target for antagonists to deliver symptomatic relief to patients with diarrhea-predominant irritable bowel syndrome (IBS-d) or carcinoid syndrome. Unfortunately, this pharmacological strategy can present side effects (e.g., severe constipation). The present study investigates the potential of a novel 5-HT3 receptor partial agonist, CSTI-300, to treat patients with IBS-d and other conditions associated with discomfort from colonic distension, with a predicted reduced side-effect profile. The in vitro and in vivo preclinical pharmacology of the drug CSTI-300 was investigated to explore the potential to treat patients with IBS-d. CSTI-300 displayed selective high affinity for the human and rat 5-HT3 receptor (Ki approximately 2.0 nM) and acted as a partial agonist (approximately 30%-50% intrinsic efficacy) in vitro. In an in vivo model of IBS-d, the rat colon distension model, CSTI-300 displayed dose-dependent efficacy. In addition, oral administration of CSTI-300 to dogs that achieved plasma levels of the drug exceeding the Ki value for the 5-HT3 receptor failed to either evoke emesis or alter the state of feces. Pharmacokinetics for CSTI-300 in rat and dog identified high levels of oral availability with t 1/2 range of 1.6-4.4 hours. The preclinical pharmacology of the lead candidate drug, CSTI-300, supports the potential of this novel drug to offer symptomatic relief to patients with irritable bowel syndrome and carcinoid syndrome with a rationale for a reduced "on-target" side-effect profile relative to 5-HT3 receptor antagonists, such as alosetron. SIGNIFICANCE STATEMENT: There is a lack of effective current treatment for diarrhea-predominant irritable bowel syndrome and carcinoid syndrome, and in both conditions, overactivity of the 5-hydroxytryptamine (5-HT) 5-HT3 receptor is thought to be implicated in the pathophysiology. Because 5-HT3 receptor blockade with antagonists results in significant side effects, we present evidence that treatment with a suitable 5-HT3 receptor partial agonist will alleviate some symptoms associated with these conditions yet, without fully inhibiting the receptor, predict a less pronounced side-effect profile associated with this therapeutic strategy.
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Affiliation(s)
- Alexander Roberts
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Gillian Grafton
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Andrew D Powell
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Kristian Brock
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Chunlin Chen
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Dejian Xie
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Jinkun Huang
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Shuang Liu
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Alison J Cooper
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Catherine A Brady
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Omar Qureshi
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Zania Stamataki
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - David D Manning
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Nicholas A Moore
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Bruce J Sargent
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Peter R Guzzo
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
| | - Nicholas M Barnes
- Neuropharmacology Research Group, Institute of Clinical Sciences (A.R., G.G., A.J.C., C.A.B., O.Q., N.M.B.) and Institute of Immunology and Immunotherapy (Z.S.), College of Medical and Dental Sciences and DB - Diagnostics, Drugs, Devices and Biomarkers, Cancer Research UK Clinical Trials Unit (K.B.), University of Birmingham, Edgbaston, Birmingham, United Kingdom; Department of Life Science, School of Health Sciences, Birmingham City University, Birmingham, United Kingdom (A.D.P.); Shanghai Medicilon Inc., Shanghai, China (C.C.); Chengdu SciMount Pharmatech Co. Ltd., Chengdu, China (D.X., J.H.); ConSynance Therapeutics, Inc., Rensselaer, New York (S.L., P.R.G.); Albany Molecular Research, Inc., Albany, New York (D.D.M., N.A.M.); and Sargent Consulting, Hendersonville, North Carolina (B.J.S.)
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