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Skov M, Ruijs TQ, Grønnebæk TS, Skals M, Riisager A, Winther JB, Dybdahl KLT, Findsen A, Morgen JJ, Huus N, Broch-Lips M, Nielsen OB, de Cuba CMKE, Heuberger JAAC, de Kam ML, Tannemaat M, Verschuuren JJGM, Knutsen LJS, Kelly NM, Jensen KG, Arnold WD, Burghes AH, Olesen C, Bold J, Petersen TK, Quiroz JA, Hutchison J, Chin ER, Groeneveld GJ, Pedersen TH. The ClC-1 chloride channel inhibitor NMD670 improves skeletal muscle function in rat models and patients with myasthenia gravis. Sci Transl Med 2024; 16:eadk9109. [PMID: 38507469 DOI: 10.1126/scitranslmed.adk9109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
Myasthenia gravis (MG) is a neuromuscular disease that results in compromised transmission of electrical signals at the neuromuscular junction (NMJ) from motor neurons to skeletal muscle fibers. As a result, patients with MG have reduced skeletal muscle function and present with symptoms of severe muscle weakness and fatigue. ClC-1 is a skeletal muscle specific chloride (Cl-) ion channel that plays important roles in regulating neuromuscular transmission and muscle fiber excitability during intense exercise. Here, we show that partial inhibition of ClC-1 with an orally bioavailable small molecule (NMD670) can restore muscle function in rat models of MG and in patients with MG. In severely affected MG rats, ClC-1 inhibition enhanced neuromuscular transmission, restored muscle function, and improved mobility after both single and prolonged administrations of NMD670. On this basis, NMD670 was progressed through nonclinical safety pharmacology and toxicology studies, leading to approval for testing in clinical studies. After successfully completing phase 1 single ascending dose in healthy volunteers, NMD670 was tested in patients with MG in a randomized, placebo-controlled, single-dose, three-way crossover clinical trial. The clinical trial evaluated safety, pharmacokinetics, and pharmacodynamics of NMD670 in 12 patients with mild MG. NMD670 had a favorable safety profile and led to clinically relevant improvements in the quantitative myasthenia gravis (QMG) total score. This translational study spanning from single muscle fiber recordings to patients provides proof of mechanism for ClC-1 inhibition as a potential therapeutic approach in MG and supports further development of NMD670.
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Affiliation(s)
- Martin Skov
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Titia Q Ruijs
- Centre for Human Drug Research, 2333 CL Leiden, Netherlands
- Leiden University Medical Centre, 2333 ZA Leiden, Netherlands
| | | | - Marianne Skals
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Anders Riisager
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | | | | | - Anders Findsen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Jeanette J Morgen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Nete Huus
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Martin Broch-Lips
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Ole B Nielsen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Ole Worms Alle 4, 8000 Aarhus C, Denmark
| | - Catherine M K E de Cuba
- Centre for Human Drug Research, 2333 CL Leiden, Netherlands
- Leiden University Medical Centre, 2333 ZA Leiden, Netherlands
| | | | | | | | | | - Lars J S Knutsen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Nicholas M Kelly
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Klaus G Jensen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - William D Arnold
- NextGen Precision Health, University of Missouri, 1030 Hitt St, Columbia, MO 65212, USA
| | - Arthur H Burghes
- Department of Biological Chemistry and Pharmacology, Ohio State University Wexner Medical Center, 1060 Carmack Road, Columbus, OH 43210, USA
- Department of Neurology, Neuromuscular Division, Ohio State University Wexner Medical Center, 395 W. 12(th) Ave, Columbus, OH 43210, USA
| | - Claus Olesen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Ole Worms Alle 4, 8000 Aarhus C, Denmark
| | - Jane Bold
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Thomas K Petersen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Jorge A Quiroz
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - John Hutchison
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Eva R Chin
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Geert J Groeneveld
- Centre for Human Drug Research, 2333 CL Leiden, Netherlands
- Leiden University Medical Centre, 2333 ZA Leiden, Netherlands
| | - Thomas H Pedersen
- NMD Pharma A/S, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Ole Worms Alle 4, 8000 Aarhus C, Denmark
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Hudkins RL, Raddatz R, Tao M, Mathiasen JR, Aimone LD, Becknell NC, Prouty CP, Knutsen LJS, Yazdanian M, Moachon G, Ator MA, Mallamo JP, Marino MJ, Bacon ER, Williams M. Discovery and Characterization of 6-{4-[3-(R)-2-Methylpyrrolidin-1-yl)propoxy]phenyl}-2H-pyridazin-3-one (CEP-26401, Irdabisant): A Potent, Selective Histamine H3 Receptor Inverse Agonist. J Med Chem 2011; 54:4781-92. [PMID: 21634396 DOI: 10.1021/jm200401v] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Robert L. Hudkins
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Rita Raddatz
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Ming Tao
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Joanne R. Mathiasen
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Lisa D. Aimone
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Nadine C. Becknell
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Catherine P. Prouty
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Lars J. S. Knutsen
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Mehran Yazdanian
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Gilbert Moachon
- Cephalon, Inc., 19 Rue Prof. Cadieux, Maisons Alfort, France
| | - Mark A. Ator
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - John P. Mallamo
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Michael J. Marino
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Edward R. Bacon
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
| | - Michael Williams
- Worldwide Discovery Research and Development, Cephalon, Inc., 145 Brandywine Parkway, West Chester, Pennsylvania 19380, United States
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