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WO2025051360A1 - Agoniste de trkb-t1 pour le traitement de l'absence épileptique et/ou de ses comorbidités - Google Patents

Agoniste de trkb-t1 pour le traitement de l'absence épileptique et/ou de ses comorbidités Download PDF

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Publication number
WO2025051360A1
WO2025051360A1 PCT/EP2023/074506 EP2023074506W WO2025051360A1 WO 2025051360 A1 WO2025051360 A1 WO 2025051360A1 EP 2023074506 W EP2023074506 W EP 2023074506W WO 2025051360 A1 WO2025051360 A1 WO 2025051360A1
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trkb
human test
test animal
absence
absence seizures
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Inventor
Vincenzo CRUNELLI
Tatiana MORAIS
Sandra Henriques VAZ
Ana Maria SEBASTIÃO
Giuseppe Di Giovanni
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Cardiff University
Universita ta Malta UM
Faculdade De Medicina Da Universidade De Lisboa
Instituto de Medicina Molecular Joao Lobo Antunes
Original Assignee
Cardiff University
Universita ta Malta UM
Faculdade De Medicina Da Universidade De Lisboa
Instituto de Medicina Molecular Joao Lobo Antunes
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Priority to PCT/EP2023/074506 priority Critical patent/WO2025051360A1/fr
Publication of WO2025051360A1 publication Critical patent/WO2025051360A1/fr
Pending legal-status Critical Current
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P25/00—Drugs for disorders of the nervous system
    • A61P25/08—Antiepileptics; Anticonvulsants
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00—Medicinal preparations containing peptides
    • A61K38/16—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/17—Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof from animals; from humans
    • A61K38/18—Growth factors; Growth regulators
    • A61K38/185—Nerve growth factor [NGF]; Brain derived neurotrophic factor [BDNF]; Ciliary neurotrophic factor [CNTF]; Glial derived neurotrophic factor [GDNF]; Neurotrophins, e.g. NT-3
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
    • G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
    • G01N33/502—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics for testing non-proliferative effects
    • G01N33/5023—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics for testing non-proliferative effects on expression patterns
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N33/00—Investigating or analysing materials by specific methods not covered by groups G01N1/00 - G01N31/00
    • G01N33/48—Biological material, e.g. blood, urine; Haemocytometers
    • G01N33/50—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing
    • G01N33/5005—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells
    • G01N33/5008—Chemical analysis of biological material, e.g. blood, urine; Testing involving biospecific ligand binding methods; Immunological testing involving human or animal cells for testing or evaluating the effect of chemical or biological compounds, e.g. drugs, cosmetics
    • G01N33/5082—Supracellular entities, e.g. tissue, organisms
    • G01N33/5088—Supracellular entities, e.g. tissue, organisms of vertebrates
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01N—INVESTIGATING OR ANALYSING MATERIALS BY DETERMINING THEIR CHEMICAL OR PHYSICAL PROPERTIES
    • G01N2800/00—Detection or diagnosis of diseases
    • G01N2800/30—Psychoses; Psychiatry

Definitions

  • Anti-Seizure Agents Field The present invention relates to agents for use in the treatment of absence seizures and their comorbidities.
  • Background Absence seizures are genetic, generalised, non-convulsive seizures that consist of sudden, relatively brief (few seconds to half a minute) lapses of consciousness that are invariably associated with generalized 2.5 – 4Hz spike/polyspike-wave discharges (SWDs), as measured via electroencephalography (EEG). Absence seizures are believed to have a complex polygenic background involving a combination of rare genetic variants and polymorphisms and are highly prevalent in paediatric and juvenile populations.
  • Absence seizures are the only clinical symptom in Childhood Absence Epilepsy (CAE), though they may often be present with other seizure types in various age-dependent and age- independent epilepsies having different severities and clinical outcomes (Crunelli et al.2020).
  • Ethosuximide and valproate are typical first-line drugs for use in the treatment of absence seizures.
  • Canonical anti-seizure medications e.g., that suppress focal and generalized convulsive seizures
  • Absence seizures are therefore believed to be fundamentally different from other seizure types, and to have a unique pharmacological profile (Crunelli et al, 2020).
  • absence seizures were considered relatively benign seizures, because of their non-convulsive nature and high remittance rate in early adulthood.
  • recent studies in large CAE cohorts now demonstrate that 30% of children with CAE exhibit pharmaco-resistant seizures (Glauser et al.2013; Cnaan et al.2017), a rate similar to that of more severe convulsive seizures. Polytherapy is therefore common and is associated with a marked increase in drug adverse effects.
  • Recent studies also show that ⁇ 60% of children with absence seizures suffer various neuropsychiatric comorbidities. Attention deficit disorders and memory and learning impairments were observed to be the most common comorbidities of absence seizures (35–40%), followed by mood disorders (Caplan et al.
  • comorbidities may precede the first absence seizure and an epilepsy diagnosis (Hermann et al.2007; Jones et al.2007) and may persist even after full pharmacological control of the seizures has been achieved (Glauser et al.2013). Moreover, comorbidities may be aggravated via the use of existing anti- seizure therapies including valproate.
  • neuropsychiatric comorbidities are currently controlled by classical pro-cognitive drugs: that is, juvenile patients receive both an anti-absence medication and a cognitive enhancer, which in turn leads to an unwanted increase in adverse effects. Consequently, there is an urgent and unmet clinical need for a new therapeutic approach to treat absence seizures and their comorbidities.
  • the present invention has been devised in light of the above considerations.
  • TrkB isoform TrkB-T1 regulates signalling at GABAergic synapses and that activation of TrkB-T1 reduces the levels of extracellular GABA by increasing the function of GAT1, one of the GABA transporters. Agonists of TrkB-T1 may therefore be useful in the treatment of absence seizures and/or their co-morbidities.
  • a first aspect of the invention provides a method of treating absence seizures and/or a comorbidity thereof, the method comprising: administering a therapeutically effective amount of a TrkB-T1 agonist to a subject in need thereof.
  • a second aspect of the invention provides a TrkB-T1 agonist for use in a method of treating absence seizures and/or a comorbidity thereof in a subject.
  • a third aspect of the invention provides the use of a TrkB-T1 agonist for the manufacture of a medicament for use in a method of treating absence seizures and/or a comorbidity thereof.
  • the method of treatment may be a method of the first aspect of the invention.
  • the method of treatment may be a method of treating absence seizures and a comorbidity thereof.
  • a fourth aspect of the invention provides a method of screening for a compound useful in treating absence seizures and/or a comorbidity thereof, comprising: determining the activity of TrkB-T1 in the presence or absence of a test compound, wherein an increase in the activity of TrkB-T1 in the presence relative to the absence of the test compound is indicative that the test compound is a candidate compound useful in treating absence seizures and/or a comorbidity thereof.
  • Methods of the fourth aspect may comprise determining the activity of isolated TrkB-T1, or determining the activity of TrkB-T1 in a mammalian cell, tissue or non-human test animal.
  • methods of the fourth aspect may be in vitro or in vivo methods.
  • Suitable non-human test animals include animal models of absence seizures.
  • a fifth aspect of the invention provides a method of screening for a compound useful in treating absence seizures and/or a comorbidity thereof, the method comprising: (i) administering a test compound to a first and a second non-human test animal; wherein the first and second non-human test animals are animal models of absence seizures; and wherein the second non-human test animal exhibits reduced expression of TrkB-T1 and/or reduced TrkB-T1 function relative to the first non-human test animal, (ii) measuring the frequency of occurrence and/or duration of absence seizures in the first and second non-human test animals, and (iii) comparing the frequency of occurrence and/or duration of absence seizures as measured in step (ii) to a control sample.
  • a reduction in the frequency of occurrence and/or duration of absence seizures in the first non-human test animal relative to the control sample, and no change or substantially no change in the frequency of occurrence and/or duration of absence seizures in the second non-human test animal relative to the control sample may be indicative that the test compound is a candidate compound useful in treating absence seizures and/or a comorbidity thereof.
  • Suitable non-human test animals (exhibiting reduced expression of TrkB-T1 and/or expressing a non-functional variant of TrkB-T1) include animals administered with a TrkB-T1 antagonist.
  • Suitable animal models of absence seizures include stargazer (STG) mice and Genetic Absence Epilepsy Rats from France (GAERS).
  • Methods of the fifth aspect of the invention may further comprise assessing a co-morbidity of an absence seizure in the first and second non-human test animals.
  • the cognitive behaviour of the first and second non-human test animals may be determined following administration of the test compound.
  • Cognitive behaviour may include learning and/or memory or the presentation of an attention- deficit/hyperactivity disorder, a cognitive impairment, a memory or learning deficit, an autism spectrum disorder, schizophrenia, depression and/or an anxiety disorder.
  • An improvement in the cognitive behaviour of the first non-human test animal as compared to the second non-human test animal may be indicative that the test compound is useful in treating a comorbidity of absence seizures.
  • a sixth aspect of the invention provides a method of screening for a compound useful in treating absence seizures and/or a comorbidity thereof, the method comprising: (i) administering a test compound to a first and a second non-human test animal; wherein the first and second non-human test animals are animal models of absence seizures, and wherein the second non-human test animal exhibits reduced expression of TrkB-T1 and/or reduced TrkB-T1 function relative to the first non-human test animal; and (ii) measuring the cognitive behaviour of the first and second non-human test animals.
  • Figure 1 shows a schematic diagram of a GABA synapse and illustrates the role of TrkB-T1 receptors in regulating the plasma membrane expression and function of GAT1, one of the GABA transporters, in astrocytes.
  • GAT1 removes GABA from the extracellular space.
  • TrkB-T1 receptors are exclusively located on astrocytes, and act as negative regulators of GAT1 recycling from the plasma membrane to the cytoplasm.
  • mice carry a single spontaneous recessive mutation in the “Stargazin” (calcium voltage-gated channel auxiliary subunit gamma 2, CACNG2) gene and exhibit head tossing, ataxia, impaired vestibular function, increased mossy fibre sprouting in hippocampus, and hyperactivity.
  • Stargazin calcium voltage-gated channel auxiliary subunit gamma 2, CACNG2
  • GAERS rats exhibit absence seizures with a frequency of SWDs of 7-11 Hz and their ontogeny is >30 days (with all animals exhibiting seizures at 3 months).
  • These rats carry unknown polygenic mutations that follow a pattern of autosomal dominant transmission and exhibit astrocytic alterations but no neuropathological abnormalities. In both animal models, absence seizures may be blocked by ethosuximide and valproic acid.
  • FIG. 3 shows a decrease in GAT1-mediated GABA uptake in brain slices derived from treatment-na ⁇ ve GAERS and Non-Epileptic Control (NEC) rats (that have no absence seizures), but no change in the GABA uptake mediated by GAT3, the other main GABA transporter in the brain.
  • NEC Non-Epileptic Control
  • FIG. 5 shows that BDNF (a TrkB-T1 agonist) increases GAT1 expression at the plasma membrane and GAT1-mediated GABA uptake in GAERS rats.
  • GAT1 67 kDa
  • expression was measured in homogenates derived from thalamic slices in the presence and absence of BDNF (30min incubation, 20ng/ml). Cytoplasmic and plasma membrane homogenates show the exclusive GAT1 expression in the plasma membrane.
  • ACSF Artificial Cerebrospinal Fluid
  • FIG. 8 shows that BDNF administration rescues absence seizures in vivo.
  • A A schematic representation of the study protocol.
  • B Systemic (i.e., intraperitoneal) administration of BDN or Vehicle 1 (Veh1) occurred 20 min after intravenous administration of Vehicle 2 (Veh2) or Elacridar (Ela) (a phosphoglycoprotein inhibitor) to allow brain penetration of BDNF.
  • FIG. 9 shows that the anti-seizure effect of BDNF is mediated via TrkB-T1 receptors.
  • A A schematic representation of the study protocol.
  • B Targeting TrkB-T1 in the cortex.
  • Total seizure duration was measured in GAERS rats administered intrathalamically with an astrocyte-specific scrambled TrkB-T1 siRNA (6.86E+10 viral particles) (closed circles) or an astrocyte-specific TrkB-T1 knockdown siRNA (6.23E+10 viral particles) (open circles) and BDNF (500ng) administrated intrathalamically to both groups of rats.
  • an astrocyte-specific scrambled TrkB-T1 siRNA (6.86E+10 viral particles) (closed circles) or an astrocyte-specific TrkB-T1 knockdown siRNA (6.23E+10 viral particles) (open circles) and BDNF (500ng) administrated intrathalamically to both groups of rats.
  • the measurement of seizure duration was normalised to pre-injection levels for each animal. Representative EEG traces can be found on the bottom of the graph.
  • Figure 10 shows that BDNF rescues the deficiencies in novel object recognition observed in GAERS rats.
  • (A) A schematic representation of the study protocol.
  • Figure 11 shows that the BDNF-mediated rescue of the impaired LTP and deficient novel object recognition of GAERS rats occurs via TrkB-T1.
  • (B) LTP magnitude was increases by ⁇ 75% in BDNF-treated compared to ACSF-treated GAERS hippocampal slices (*, P 0,0161; unpaired t-test).
  • (D) LTP magnitude was not different between ACSF- and BDNF-treated GAERS hippocampal slices (P 0.114, unpaired t-test).
  • G Graphical representation of the percentage of time each GAERS rat spends exploring the familiar (black) and the novel (white) object for astrocyte-specific scrambled TrkB-T1 siRNA- and astrocyte-specific TrkB-T1 knockdown siRNA-injected animals.
  • the invention relates to the treatment of absence seizures and their comorbidities by administering a therapeutically effective amount of a TrkB-T1 agonist to a subject in need thereof.
  • TrkB-T1 agonists Activation of TrkB-T1 receptors by TrkB-T1 agonists are shown herein to act as negative regulators of GAT1 recycling from the plasma membrane to the cytoplasm: this decreases the levels of extracellular GABA which in turn rescues both absence seizures and their memory comorbidity.
  • TrkB-T1 agonists significantly reduce the frequency of occurrence and duration of absence seizures in vivo and are effective in alleviating the memory/learning comorbidities, such as deficiencies in novel object recognition that are typical of animal models of absence seizures.
  • TrkB-T1 agonists may be useful in the treatment of absence seizures and their comorbidities.
  • TrkB-T1 is a truncated variant of Tropomyosin receptor kinase B (TrkB). TrkB is also known as tyrosine receptor kinase B, BDNF/NT-3 growth factors receptor, or neurotrophic tyrosine kinase receptor type, and may also be termed TrkB full-length (“Trkb-FL”). TrkB-FL is encoded by the gene NTRK2 in humans and mice (Homo sapiens gene ID 4915; Mus musculus gene ID 18212).
  • TrkB-T1 is located exclusively on astrocytes and is the major isoform of TrkB-FL that is expressed in the adult mammalian brain.
  • TrkB-T1 as described herein may be present in thalamic, cortical or hippocampal astrocytes.
  • An overview of the role of the astrocytic TrkB-T1 in regulating the expression of GAT1 at GABAergic synapses is shown in Figure 1.
  • TrkB-FL may be human TrkB-FL and may have the amino acid sequence of UniProt Q16620-1 (Homo sapiens) (SEQ ID NO: 3) or a variant thereof.
  • TrkB-T1 may be human TrkB-T1 and may have the amino acid sequence of UniProt Q16620-2 (Homo sapiens) (SEQ ID NO: 4) or a variant thereof.
  • TrkB-FL may be mouse TrkB-FL and may have the amino acid sequence of UniProt P15209-1 (Mus musculus) (SEQ ID NO: 1) or a variant thereof.
  • TrkB-T1 may be mouse TrkB-T1 and may have the amino acid sequence of UniProt P15209-2 (Mus musculus) (SEQ ID NO: 2) or a variant thereof.
  • a TrkB-T1 agonist is an agent that is capable of stimulating or activating a TrkB-T1 receptor.
  • TrkB-T1 may enhance the acidic metabolite release from a cell (Baxter et al., 1997) and elicit calcium transients, i.e. calcium release from intracellular stores, in astrocytes (Rose et al., 2003).
  • a “full agonist” may achieve the maximum possible biological response, whilst a “partial agonist” may generate a partial biological response with equivalent receptor occupancy.
  • a TrkB-T1 agonist as described herein may be a selective agonist of TrkB-T1.
  • a selective agonist is an agonist that is selective for a particular species of receptor over one or more other species of receptor.
  • a selective agonist of TrkB-T1 may exhibit a higher binding affinity for TrkB-T1 than for TrkB-FL.
  • a selective agonist of TrkB-T1 may exhibit a binding affinity (Kd) for TrkB-T1 that is lower than its binding affinity (Kd) for TrkB-FL.
  • a TrkB-T1 agonist disclosed herein may for example exhibit a Kd value in the range of picomolar (10 -12 M) to micromolar (10 -6 M) concentrations, such as a Kd value between 1, 10 or 100 pM and 1, 10 or 100 ⁇ M.
  • a selective agonist of TrkB-T1 may also exhibit higher efficacy (in eliciting a biological response) on binding to TrkB-T1 compared to binding to TrkB-FL.
  • a selective agonist of TrkB-T1 may exhibit a half effective concentration (EC50) for activation of TrkB-T1 that is lower than its half effective concentration (EC 50 ) for activation of TrkB-FL.
  • a non-selective agonist of TrkB may activate both TrkB-T1 and TrkB-FL.
  • BDNF brain-derived neurotrophic factor
  • a TrkB-T1 agonist disclosed herein may exhibit an EC50 value in the range of picomolar (10 -12 M) to micromolar (10 -6 M) concentrations, for example, an EC50 between 1 pM, 10 pM or 100 pM and 1 ⁇ M, 10 uM or 100 ⁇ M.
  • Methods suitable for assessing the binding affinity (Kd) and half effective concentration (EC50) of an agonist are well known in the art (see e.g.
  • TrkB-T1 agonists include an organic compound having a molecular weight of 900 Da or less; a protein or peptide that specifically binds TrkB-T1, for example, an antibody molecule that specifically binds TrkB-T1, or a peptide that binds TrkB-T1 and enhances its activity (an agonist peptide); and a nucleic acid that specifically binds TrkB-T1, for example, an aptamer that specifically binds TrkB-T1.
  • TrkB-T1 agonists may include brain derived neurotrophic factor (BDNF; Gene ID 627; reference sequence NP_001137277.1) and variants and derivatives thereof.
  • BDNF brain derived neurotrophic factor
  • a TrkB-T1 agonist as described above may be administered alone or may be formulated into a pharmaceutical composition.
  • a pharmaceutical composition is a formulation comprising one or more active agents and one or more pharmaceutically acceptable excipients. The pharmaceutical composition may be capable of eliciting a therapeutic effect.
  • a suitable pharmaceutical composition for use as described herein may comprise an agent described above and a pharmaceutically acceptable excipient.
  • a pharmaceutical composition may comprise a TrkB-T1 agonist as described herein, and a pharmaceutically acceptable excipient, carrier, diluent, or adjuvant.
  • pharmaceutically acceptable relates to compounds, materials, compositions, and/or dosage forms which are, within the scope of sound veterinary or medical judgement, suitable for use in contact with the tissues of a subject (e.g. human or other mammal) without excessive toxicity, irritation, allergic response, or other problem or complication, and that are commensurate with a reasonable benefit/risk ratio.
  • a subject e.g. human or other mammal
  • Each carrier, excipient, etc. must be “acceptable” in the sense of being compatible with the other ingredients of the formulation.
  • Suitable excipients and carriers include, without limitation: water, saline, buffered saline, phosphate buffer, alcoholic/aqueous solutions, emulsions or suspensions.
  • Such carriers can include ethanol, polyols, and suitable mixtures thereof, vegetable oils, and injectable organic esters.
  • Buffers and pH-adjusting agents may also be employed, and include, without limitation, salts prepared from an organic acid or base.
  • Representative buffers include, without limitation: organic acid salts, such as salts of citric acid (e.g., citrates), ascorbic acid, gluconic acid, carbonic acid, tartaric acid, succinic acid, acetic acid, phthalic acid, Tris, trimethylamine hydrochloride, or phosphate buffers.
  • Parenteral carriers can include sodium chloride solution, Ringer's dextrose, dextrose, trehalose, sucrose, lactated Ringer's, or fixed oils.
  • Intravenous carriers can include fluid and nutrient replenishers, electrolyte replenishers, such as those based on Ringer's dextrose, and the like.
  • Preservatives and other additives such as, for example, antimicrobials, antioxidants, chelating agents (e.g., EGTA; EDTA), inert gases, and the like may also be provided in the pharmaceutical carriers.
  • the pharmaceutical compositions described herein are not limited by the selection of the carrier.
  • compositions from the above-described components, having appropriate pH, isotonicity, stability and other conventional characteristics, is within the skill of the art.
  • Suitable carriers, diluents, excipients, etc. can be found in standard pharmaceutical texts. See, for example, Handbook of Pharmaceutical Additives, 2 nd Edition, 2001, Remington's Pharmaceutical Sciences, 20 th Edition, 2000; and Handbook of Pharmaceutical Excipients, 2 nd Edition, 1994.
  • a pharmaceutical composition may conveniently be presented in unit dosage form and may be prepared by any methods well-known in the art of pharmacy. Such methods include the step of bringing the one or more TrkB-T1 agonists into association with a carrier or excipient as described above which may constitute one or more accessory ingredients.
  • the formulations are prepared by uniformly and intimately bringing into association the active compound with liquid carriers or finely divided solid carriers or both.
  • Pharmaceutical compositions described herein may be produced in various forms, depending upon the route of administration. Routes may include parenteral, intravenous, intraarterial, intramuscular, oral and nasal routes.
  • the pharmaceutical compositions may include liquid or solid forms and may be prepared for administration to subjects in the form of, for example, liquids, powders, aerosols, tablets, capsules, enteric-coated tablets or capsules, or suppositories.
  • Pharmaceutical compositions may also be in the form of suspensions, solutions, emulsions in oily or aqueous vehicles, pastes, and implantable sustained- release or biodegradable formulations.
  • compositions for sustained release or implantation may comprise pharmaceutically acceptable polymeric or hydrophobic materials, such as an emulsion, an ion exchange resin, a sparingly soluble polymer, or a sparingly soluble salt.
  • Pharmaceutical compositions may be made in the form of sterile aqueous solutions or dispersions, suitable for injectable use, or made in lyophilized forms using freeze-drying techniques. Lyophilized pharmaceutical compositions are typically maintained at about 4°C, and can be reconstituted in a stabilizing solution, e.g., saline or HEPES, with or without adjuvant.
  • Pharmaceutical compositions can also be made in the form of suspensions or emulsions.
  • the carrier or other material will depend on the route of administration, which may be any convenient route, for example by injection, e.g. cutaneous, subcutaneous, or intravenous.
  • the agent is administered systemically, e.g. intravenously.
  • the pharmaceutical compositions comprising the active compounds may be formulated in a dosage unit formulation that is appropriate for the intended route of administration.
  • Pharmaceutical compositions may be presented in unit-dose or multi-dose sealed containers, for example, ampoules and vials, and may be stored in a freeze-dried (lyophilised) condition requiring only the addition of the sterile liquid carrier, for example water for injections immediately prior to use.
  • Methods of determining the most effective means and dosage of administration are well known in the art and will vary with the formulation used for therapy, the purpose of the therapy, the target cell being treated, and the subject being treated. Single or multiple administrations can be carried out with the dose level and pattern being selected by the physician. Administration in vivo can be effected in one dose, continuously or intermittently (e.g., in divided doses at appropriate intervals). Multiple doses of the composition may be administered, for example 2, 3, 4, 5 or more than 5 doses may be administered. The administration of the composition may continue for sustained periods of time. For example, treatment with the composition may be continued for at least 1 week, at least 2 weeks, at least 3 weeks, at least 1 month or at least 2 months.
  • a TrkB-T1 agonist may be useful in treating an absence seizure and/or one or more of their comorbidities in a patient.
  • An absence seizure is a genetic, generalised, non-convulsive seizure that consists of sudden, relatively brief (few seconds to half a minute) lapses of consciousness that are associated with generalized 2.5 – 4Hz spike/polyspike-wave discharges (SWDs), as measured via electroencephalography (EEG).
  • SWDs spike/polyspike-wave discharges
  • EEG electroencephalography
  • absence seizures may be accompanied by convulsive seizures.
  • a comorbidity of an absence seizure is a clinical manifestation that accompanies or is associated with an absence seizure.
  • a comorbidity may occur before the first absence seizure or the first diagnosis of an absence seizure in a patient and may persist even after full pharmacological control of the absence seizures in a patient.
  • Comorbidities of absence seizures may include neuropsychiatric comorbidities such as attention-deficit/hyperactivity disorder, cognitive impairment, memory and learning deficits, autism spectrum disorder, schizophrenia, depression and anxiety disorders (such as agoraphobia, selective mutism, generalized anxiety disorder (GAD), social anxiety disorder, obsessive-compulsive disorder (OCD) and panic disorder).
  • Treatment may be any treatment and therapy, whether of a human or an animal (e.g. in veterinary applications), in which some desired therapeutic effect is achieved, for example, improving or ameliorating one or more symptoms of an absence seizure or comorbidity. Treatment may be preventative or curative.
  • An subject suitable for treatment as described above may be a mammal, such as a rodent (e.g. a guinea pig, a hamster, a rat), murine (e.g. a mouse), canine (e.g. a dog), feline (e.g.
  • a cat equine
  • a primate e.g. a monkey or ape
  • a monkey e.g. marmoset, baboon
  • an ape e.g. gorilla, chimpanzee, orang-utan, gibbon
  • the subject is a human.
  • non-human mammals especially mammals that are conventionally used as models for demonstrating therapeutic efficacy in humans (e.g. murine, rodent, primate, porcine, canine, or leporid) may be employed.
  • Suitable subjects for treatment as described here include a human paediatric subject having Childhood Absence Epilepsy (CAE), a teenage human subject having Juvenile Absence Epilepsy (JAE), and a young or adult subject having absence as well as convulsive seizures.
  • a subject may carry a dysfunctional or non-functional sodium- and chloride-dependent GABA transporter 1 (GAT1), for example, caused by a loss-of-functional SLC6A1 gene variant.
  • SLC6A1 Homo sapiens gene ID 6529; Mus musculus gene ID 232333 encodes GABA transporter 1 (GAT1).
  • GAT1 is expressed on astrocytes and is responsible for removing GABA from the synaptic cleft at GABAergic synapses.
  • TrkB-T1 agonists are shown herein to reduce the internalisation of GAT1, thereby increasing the expression of GAT1 in the plasma membrane and thus facilitating an increase in GAT1-mediated GABA uptake at the synapse.
  • An individual with an absence seizure or comorbidity may display at least one identifiable sign, symptom, or laboratory finding that is sufficient to make a diagnosis of absence seizure or comorbidity in accordance with clinical standards known in the art. Examples of such clinical standards can be found in textbooks of medicine. It will be appreciated that appropriate dosages of a TrkB-T1 agonist may vary from patient to patient.
  • Determining the optimal dosage will generally involve the balancing of the level of therapeutic benefit against any risk or deleterious side effects of the treatments of the present invention.
  • the selected dosage level will depend on a variety of factors including, but not limited to, the activity of the particular agent, the route of administration, the time of administration, the rate of loss or inactivation of the agent, the duration of the treatment, other drugs, compounds, and/or materials used in combination, and the age, sex, weight, condition, general health, and prior medical history of the patient.
  • the dosage of agent and the route of administration will ultimately be at the discretion of the physician, although generally the dosage will be to achieve local concentrations at the site of injury which achieve the desired effect without causing substantial harmful or deleterious side-effects.
  • Prescription of treatment e.g.
  • a therapeutically effective amount or suitable dose of a agent described herein may be determined by comparing its in vitro activity and in vivo activity in an animal model. Methods for extrapolation of effective dosages in mice and other test animals to humans are known. Treatment may comprise the administration of a therapeutically effective amount of the agent or pharmaceutical composition to the individual. “Therapeutically effective amount” relates to the amount of a agent or pharmaceutical composition that is effective for producing some desired therapeutic effect, commensurate with a reasonable benefit/risk ratio.
  • a suitable amount of a agent or pharmaceutical composition for administration to an individual may be an amount that generates a therapeutic effect in the individual.
  • a therapeutic effect may be at least amelioration of at least one symptom.
  • a treatment as described herein may have a duration of up to 3 weeks, up to 6 weeks, up to 3 months, up to 6 months or up to 12 months.
  • the treatment schedule for an individual may be dependent on the pharmacokinetic and pharmacodynamic properties of the agent, the route of administration and the nature of the condition being treated. Treatment may be in one dose, continuously or intermittently (e.g., in divided doses at appropriate intervals).
  • Treatment may be periodic, and the period between administrations may be about 12 hours or more, 24 hours or more, 36 hours or more, 48 hours or more, 96 hours or more, or one week or more. Suitable formulations and routes of administration are described above and may be readily determined by a physician for any individual patient.
  • the TrkB-T1 agonist may be administered for the treatment absence seizures and/or co-morbidities without the co-administration of other therapies.
  • a TrkB-T1 agonist may be administered in combination with one or more other therapies, either simultaneously or sequentially dependent upon the circumstances of the individual to be treated.
  • the second pharmaceutical agent may be an anti-seizure agent. Appropriate anti-seizure agents will be readily appreciated by those skilled in the art.
  • TrkB-T1 agonists When TrkB-T1 agonists are used in combination with additional therapeutic agents, the compounds may be administered either sequentially or simultaneously by any convenient route. When TrkB-T1 agonists are used in combination with an additional therapeutic agent active against the same disease, the dose of each agent in the combination may differ from that when the therapeutic agents are used alone. Appropriate doses will be readily appreciated by those skilled in the art.
  • TrkB-T1 may be useful in screening for compounds that may be useful in the development of therapeutics for treating absence seizures and/or co-morbidities of absence seizures. A method of screening for a compound useful in treating absence seizures and/or a comorbidity thereof may comprise determining the activity of TrkB-T1 in the presence or absence of a test compound.
  • TrkB-T1 An increase in the activity of TrkB-T1 in the presence relative to the absence of the test compound is indicative that the test compound is a TrkB-T1 agonist and is a candidate compound useful in treating absence seizures and/or a comorbidity thereof.
  • Methods described herein may comprise determining the activity of isolated TrkB-T1, or the activity of TrkB-T1 in a mammalian cell, a mammalian tissue or non-human mammal.
  • a method of screening for a compound useful in treating absence seizures and/or a comorbidity thereof may comprise determining the activity of TrkB-T1 and TrkB-FL in the presence or absence of a test compound.
  • TrkB-T1 An increase in the activity of TrkB-T1 in the presence relative to the absence of the test compound that is greater than the increase in the activity of TrkB-FL in the presence relative to the absence of the test compound may be indicative that the test compound is a selective TrkB-T1 agonist and is a candidate compound useful in treating absence seizures and/or a comorbidity thereof.
  • the activity of TrkB-T1 may increase in the presence relative to the absence of the test compound and the activity of TrkB-FL may not increase or may decrease in the presence relative to the absence of the test compound.
  • Methods suitable for determining the activity of TrkB-T1, TrkB-FL and GAT1 are well known in the art and are readily available to those skilled in the art (see e.g.
  • suitable methods may involve assessing the expression of TrkB-T1, TrkB-FL and GAT1 at the plasma membrane, assessing modifications thereof (e.g. dimerization, phosphorylation), and/or assessing biological responses produced by cells or organisms in which the TrkB-T1, TrkB-FL or GAT1 are expressed.
  • Biophysical techniques for example X-ray crystallography, cryo-electron microscopy, and nuclear magnetic resonance spectroscopy may also be used in order to determine the location of TrkB-T1, TrkB-FL and GAT1 and to characterise any conformational changes that occur upon ligand binding and/or activation.
  • determining the activity of TrkB-T1 comprises measuring the expression of GABA transporter 1 (GAT1) at the plasma membrane or measuring the trafficking of GAT1 between the cytoplasm and the plasma membrane.
  • GAT1 GABA transporter 1
  • Suitable methods include enzyme-linked immunosorbent assay (ELISA), immunohistochemistry (IHC), or immunofluorescence (IF).
  • ELISA enzyme-linked immunosorbent assay
  • IHC immunohistochemistry
  • IF immunofluorescence
  • the expression profile may also be quantified using flow cytometry and associated techniques (e.g. time-of-flight (TOF) cytometry or mass spectrometry, CyTOF).
  • TOF time-of-flight
  • CyTOF mass spectrometry
  • Methods described herein may comprise determining the activity of isolated TrkB-T1, or the activity of TrkB-T1 in a mammalian cell, a mammalian tissue or non-human mammal.
  • a test compound showing activity in an in vitro method described herein may be subsequently tested in one or more in vivo methods described herein.
  • a method of screening for a compound useful in treating absence seizures and/or a comorbidity thereof comprising: (i) administering a test compound to a first and a second non-human test animal; in which the first and second non-human test animals are animal models of absence seizures, and in which the second non-human test animal exhibits reduced expression of TrkB-T1 and/or reduced TrkB-T1 function as compared to the first non-human test animal; (ii) measuring the frequency of occurrence and/or duration of absence seizures in the first and second non-human test animals, and (iii) comparing the frequency of occurrence and/or duration of absence seizures as measured in step (ii) to a control sample; in which a reduction in the frequency of occurrence and/or duration of absence seizures in the first non-human test animal relative to the control sample, and substantially no change in the frequency of occurrence and/or duration of absence seizures in the second non-human test animal relative to the control sample are indicative that the test compound is a candidate
  • Suitable animal models of absence seizures include GAERS rat and Stargazer mouse as described herein.
  • the non-human test animal exhibiting reduced expression of TrkB-T1 or expressing a non- functional variant of TrkB-T1 may be an animal administered with a TrkB-T1 antagonist.
  • a TrkB-T1 antagonist is agent that is capable of binding to and inhibiting the activation of TrkB-T1.
  • the antagonist may bind to the agonist binding site, or may achieve inhibition by allosteric modulation of TrkB-T1.
  • An antagonist may exhibit affinity for the agonist binding site of the TrkB-T1, but without exhibiting efficacy (i.e., without stimulating receptor signalling).
  • a suitable TrkB-T1 antagonist may be a competitive antagonist of a TrkB-T1 agonist.
  • Antagonists may also include agents that are capable of inhibiting the expression of a signalling receptor.
  • a suitable TrkB-T1 antagonists may include competitive antagonists of the test compound, an allosteric modulator of TrkB- T1, a TrkB-T1 small interfering RNA (siRNA), and a TrkB-T1 microRNA (miRNA).
  • Suitable TrkB-T1 antagonists may also include selective antagonists of TrkB-T1 on astrocytes.
  • a selective antagonist of TrkB-T1 may exhibit a half inhibitory concentration (IC50) for TrkB-T1 that is lower than its half inhibitory concentration (IC50) for TrkB-FL.
  • IC50 half inhibitory concentration
  • a TrkB-T1 antagonist suitable for use as described may exhibit an IC50 value in the range of picomolar (10 -12 M) to micromolar (10 -6 M) concentrations, for example, between 1, 10 or 100 pM and 1, 10 or 100 ⁇ M.
  • SEQ ID NO: 5 is a suitable TrkB-T1 antagonist.
  • test compound may be an isolated molecule or may be comprised in a sample, mixture or extract, for example, a biological sample.
  • Compounds which may be screened using the methods described herein may be natural or synthetic chemical compounds used in conventional drug screening programmes.
  • Extracts of plants, microbes or other organisms, which contain several characterised or uncharacterised components may also be used.
  • Suitable test compounds may include analogues, derivatives, variants and mimetics of known TrkB-T1 agonists, such as BDNF.
  • compounds produced using rational drug design to provide test candidate compounds with particular molecular shape, size and charge characteristics suitable for the selective agonism of TrkB-T1 may be tested.
  • a combinatorial library technology provides an efficient way of testing a potentially vast number of different compounds for their ability to act as agonists of TrkB-T1, preferably selective agonists of TrkB- T1.
  • Such libraries and their use are known in the art, for all manner of natural products, small molecules and peptides, among others.
  • test compound which may be added to a screening assay of the invention will normally be determined by trial and error depending upon the type of compound used. Typically, from about 0.001 nM to 1 mM or more concentrations of putative agonist compound may be used, for example from 0.01 nM to 100 ⁇ M, e.g.0.1 to 50 ⁇ M, such as about 10 ⁇ M. Even a compound having a weak agonist effect may be a useful lead compound for further investigation and development.
  • the precise format of any of the screening or assay methods disclosed herein may be varied by those of skill in the art using routine skill and knowledge. The skilled person is well aware of the need to employ appropriate control experiments.
  • suitable control samples include, for example, reference values, treatment-na ⁇ ve non-human test animals, and non-human test animals administered a control compound (e.g. a vehicle control), in which the control compound does not exhibit anti-seizure activity, and in which the control compound is not a TrkB-T1 agonist nor a TrkB-T1 antagonist.
  • a control compound e.g. a vehicle control
  • Non-human test animals may be species of rodent (e.g., mouse, rat, guinea pig, hamster, gerbil), fly (e.g., Drosophila) fish (e.g., zebrafish), livestock (e.g.
  • the non-human test animal is an animal model of absence seizures.
  • the non-human test animal may be an inbred laboratory rodent, such as a GAERS rat (Vergnes et al.1982; Micheletti et al.1985; Marescaux et al.1992).
  • the non-human test animal may be a genetically modified animal or an animal with a single spontaneous gene mutation, such an STG mouse.
  • suitable methods may involve DNA recombination, gene knockout (e.g., via homologous recombination or through the use of nucleases), gene insertion (e.g., cisgenesis or transgenesis), RNA interference (RNAi), genome editing (for example using CRISPR-Cas9 and associated techniques) or via mutagenesis (which may be random or targeted).
  • gene knockout e.g., via homologous recombination or through the use of nucleases
  • gene insertion e.g., cisgenesis or transgenesis
  • RNAi RNA interference
  • genome editing for example using CRISPR-Cas9 and associated techniques
  • mutagenesis which may be random or targeted.
  • the non-human test animal may be a genetically modified animal comprising a calcium voltage-gated channel auxiliary subunit gamma 2 (CACNG2) gene variant (Homo sapiens gene ID 10369; Mus musculus gene ID 12300).
  • CACNG2 gene variant in which the altered gene product lacks the molecular function of the wild-type gene product.
  • the gene variant may comprise a partial or total deletion of the CACNG2 gene.
  • the non-human test animal may exhibit a dysfunctional or non-functional CACNG2 protein. For example, Stargazer mice (Letts et al., 1997; Letts et al., 1998; Seo and Leitch, 2014).
  • TrkB-T1 A candidate compound identified as a selective agonist of TrkB-T1 may be investigated further.
  • the selectivity of a compound for TrkB-FL and/or TrkB-T1 in astrocytes may be determined in animal models. Suitable methods for determining the effect of a compound on TrkB-T1 are disclosed herein and alternative methods are well known in the art.
  • a candidate compound identified as a TrkB-T1 agonist through one or more of the screening methods disclosed herein may be isolated and/or purified. Alternatively, it may be synthesised using conventional techniques of recombinant expression or chemical synthesis. Furthermore, it may be manufactured and/or used in preparation, i.e. manufacture or formulation, of a composition such as a medicament, pharmaceutical composition or drug. Methods described herein may thus comprise formulating the test compound in a pharmaceutical composition with a pharmaceutically acceptable excipient, vehicle or carrier for therapeutic application. Following identification of a TrkB-T1 agonist that is potentially useful in the treatment of absence seizures and/or their comorbidities as described herein, a method may further comprise modifying the compound to optimise its pharmaceutical properties.
  • Suitable methods of optimisation for example by structural modelling, are well known in the art. Further optimisation or modification can then be carried out to arrive at one or more final compounds for in vivo or clinical testing.
  • Other aspects and embodiments of the invention provide the aspects and embodiments described above with the term “comprising” replaced by the term “consisting of” and the aspects and embodiments described above with the term “comprising” replaced by the term ”consisting essentially of”.
  • the term “in vitro” relates to actions performed in isolated laboratory conditions or in cell culture, for example using materials, biological substances, cells and/or tissues that are isolated from an organism.
  • the term “in vivo” relates to actions performed in intact multi-cellular organisms, such as humans or other mammals.
  • ex vivo relates to actions performed outside a multi-cellular organisms e.g. outside a human or mammalian body, which may be on tissue (e.g. whole organs) or cells obtained or derived from a multi-cellular organism. It is to be understood that the application discloses all combinations of any of the above aspects and embodiments described above with each other, unless the context demands otherwise. Similarly, the application discloses all combinations of the preferred and/or optional features either singly or together with any of the other aspects, unless the context demands otherwise. Modifications of the above embodiments, further embodiments and modifications thereof will be apparent to the skilled person on reading this disclosure, and as such, these are within the scope of the present invention.
  • Figure 3 shows a decrease in GAT1-mediated GABA uptake in brain slices derived from treatment-na ⁇ ve GAERS and Non-Epileptic Control (NEC) rats (that have no absence seizures), but no change in the GABA uptake mediated by GAT3, the other main GABA transporter in the brain.
  • NEC Non-Epileptic Control
  • MC motor cortex
  • SC visual cortex
  • VC visual cortex
  • HIPPO hippocampus
  • Transverse 300 ⁇ m slices were then cut from each region using a McIlwain tissue chopper and allowed to recover for 1 hour (Fredholm et al., 1984) in small chambers filled with Krebs solution saturated with 5% CO2 - 95% O2.
  • drugs of interest namely 20 ⁇ M SKF-8996A (a GAT1 blocker) and 20 ⁇ M SNAP-5411 (a GAT3 blocker) were added to the ACSF solution.
  • the uptake assay was then started by immersion of the slices for 10 min in a solution containing 2.5, 5, 10, 25, 50 and 100 ⁇ M of GABA (10% of which was [3H]GABA with specific activity of 0.141 Ci/mmol, PerkinElmer, Boston, MA, USA) with or without the drugs of interest in DMEM medium (DMEM, Gibco, Paisley, UK),) at 37oC.
  • DMEM medium DMEM, Gibco, Paisley, UK
  • the slices were washed twice in an ice-cold PBS solution (in mM: 140 NaCl, 2.7 KCl, 1.5 KH2PO4 and 8.1 NaHPO4, pH 7.40), and then homogenized in 200 ⁇ l of lysis buffer (in mM: 100 NaOH and 0.1% SDS).
  • Figure 4 shows a decrease in GAT1-mediated, but not GAT3-mediated, GABA uptake in primary cultures of astrocytes derived from treatment-na ⁇ ve GAERS and NEC rats.
  • GABA uptake assays were carried out in primary cultures of astrocytes.
  • Primary cultures of astrocytes were prepared from the cerebral cortex and the thalamus of neonatal GAERS and NEC rat pups (0–3 days old) (Morais et al, 2018). Briefly, rat pups were sacrificed by decapitation and the brains were dissected in ice cold phosphate buffered saline solution (PBS) containing 137 mM NaCl, 2.7 mM KCl, 8 mM Na2HPO4.2H2O and 1.5 mM KH2PO4 (pH 7.4).
  • PBS ice cold phosphate buffered saline solution
  • DMEM Modified Eagles Medium
  • the pellet was resuspended in 4.5 g/l glucose DMEM, sorted again through a 70- ⁇ m cell strainer (BD Falcon, NJ, USA) and then centrifuged. The final pellet was resuspended in DMEM and seeded at the density of 2x105 or 5x105 cells/ml (for thalamic cultures) and 5x105 cells/ml (for cortical cultures) in 24 wells plates. Thalamic and cortical astrocyte cultures were grown for 3 weeks in an incubator at 37oC with a humidified atmosphere of 95% O2 and 5% CO2. The culture medium was changed twice a week.
  • astrocytes were shaken for 5 hours at 300 rpm to remove any contaminating microglia cells.
  • GABA uptake assays were performed in 21 days-old primary cultures of astrocytes following the procedures described by Vaz et al. (2011). Briefly, 3h before the uptake assay, the cell culture medium was changed to serum-free 1g/L DMEM medium, and the cells were kept at 37oC with 95% O2 - 5% CO2.
  • a solution made of the drugs of interest diluted in the culture medium was added to the culture medium (10 ⁇ l/well), namely, 20 ⁇ M SKF-8996A (a GAT1 antagonist) or 20 ⁇ M SNAP-5411 (a GAT3 antagonist), and to some culture wells 10 ⁇ l of culture medium (without any drugs) was added for these wells to serve as controls.
  • GABA uptake assay was performed by removing the culture medium from the wells and then incubating the cells for 60 s at 37oC with 1, 2.5, 5, 10, 25 and 50 ⁇ M of GABA, (from a stock solution that contained 10% of [3H]GABA ([3H]GABA specific activity: 0.141 Ci/mmol) (PerkinElmer, Boston, MA, USA) and drugs of interest, namely SKF-8996A and SNAP-5411, in a solution of (in mM) 137 NaCl, 5.4 KCl, 1.8 CaCl2 ⁇ 2H2O, 1.2 MgSO4 and 10 HEPES (pH adjusted with NaOH to 7.40).
  • the GABA solutions were aspirated from the wells and an ice-cold STOP solution (in mM: 137 NaCl and 10 HEPES, pH adjusted with Tris-base to 7.40) was added to the wells, twice, and the cells were then washed in PBS. Cellular solubilization was then performed for 1 hour at room temperature by adding 200 ⁇ L lysis buffer (in mM: 100 NaOH and 0.1% SDS (Sodium Dodecyl Sulfate)) per well.
  • lysis buffer in mM: 100 NaOH and 0.1% SDS (Sodium Dodecyl Sulfate)
  • slices were incubated for 30min in 250 ⁇ l of RIPA buffer [50mM Tris pH 8.0, 1mM EDTA, 150mM NaCl, 1% NP40 (Nonyl phenoxlpoylethanol, from Fluka Biochemika, Switzerland), 1% SDS and 10% glycerol] with 25x protease inhibitors (Complete Mini-EDTA free, Roche, Germany) and 1mM PMSF to perform cell lysis.
  • RIPA buffer 50mM Tris pH 8.0, 1mM EDTA, 150mM NaCl, 1% NP40 (Nonyl phenoxlpoylethanol, from Fluka Biochemika, Switzerland), 1% SDS and 10% glycerol
  • 25x protease inhibitors Complete Mini-EDTA free, Roche, Germany
  • PMSF 1mM PMSF
  • Lysates were then centrifuged at 4oC for 10min and at 11000g. The supernatant was stored at -20 oC until further use.
  • Total protein in lysates obtained from primary cultures and brain slices was quantified with Bio-Rad DC reagent (Hercules, CA, USA) Bradford’s Assay, using BSA (Bovine Serum Albumin) as the standard to establish the calibration curves. Concentrations of 0, 0.05, 0.1, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9 and 1 ⁇ g/ ⁇ l BSA were used to correlate protein concentration and absorbance, allowing the quantification of proteins.
  • Membranes were then blocked at room-temperature with 3% BSA in TBS-T (20 mM Tris base, 137 mM NaCl and 0, 1% Tween- 20) for 1 h and incubated with the primary antibody overnight at 4oC. On the following day, membranes were washed twice for 10 minutes with TBS-T and incubated for 1 h with the secondary antibody at room temperature. Image acquisition was performed by ECL Plus Western Blotting Detection System (Amersham-ECL Western Blotting Detection Reagents from GE Healthcare, Buckinghamshire, UK) and visualized with the ChemiDocTM XRS+Imager system (Hercules, CA, USA).
  • GAT1 glyceraldehyde 3-phosphate dehydrogenase
  • Figure 6 shows a decrease in GAT1-mediated GABA uptake in brain slices derived from treatment-na ⁇ ve STG compared to wildtype (WT) control mice.
  • GABA uptake in 12 weeks-old STG mice and their WT littermates was assessed, and the effect of BDNF upon the increase on GAT1-mediated GABA uptake was also measured using the methods described above for GAERS uptake.
  • TrkB-T1 agonists improve the deficient synaptic correlate of memory
  • Figure 7 shows that BDNF rescues the deficient hippocampal long-term potentiation (LTP) of GAERS rats. Twelve to 16 weeks old animals were used to evaluate synaptic plasticity using extracellular recordings of field excitatory postsynaptic potentials (fEPSPs) in GAERS and NEC as the cellular correlate of memory disfunction and the effect of BDNF upon LTP was evaluated. To obtain hippocampal slices, animals were deeply anesthetized with isoflurane, and dissection of the two hippocampi was rapidly made in ice-cold Krebs solution.
  • fEPSPs field excitatory postsynaptic potentials
  • Hippocampal slices 400 ⁇ m thick were cut perpendicularly using a McIlwain tissue chopper and recovered for 1h upon incubation at room temperature in oxygenated Krebs solution (5% CO2, 95% O2). After the recovery period, one slice at a time was placed in the recording chamber and continuously superfused with oxygenated Krebs solution at a constant flow of 3 ml/min and 32 °C.
  • a microelectrode filled with Krebs solution (2–6 M ⁇ resistance) was placed in the stratum radiatum of the CA1 region of the hippocampus, coupled to an Axoclamp 2B Amplifier (Axon Instruments) and the traces digitized with a BNC-2110 (National Instruments).
  • Stimulation (rectangular, 0.1 ms pulses every 20 seconds) was delivered through a concentric electrode placed on the Schaffer collateral-commissural fibres, in the stratum radiatum, near the CA3-CA1 border (P0) and near CA1 (P1). Stimulation alternately of two pathways of the Schaffer collateral-commissural fibres was performed. Individual responses were monitored, and averages of eight consecutive responses were continuously stored using WinLTP Software. LTP was induced by ⁇ -burst stimulation (TBS) since this pattern of stimulation is similar to what occurs physiologically in the hippocampus during episodes of learning and memory.
  • TBS ⁇ -burst stimulation
  • LTP was induced using TBS delivered at basal stimulus intensity, comprising of 5 bursts (200 ms interburst interval) at 5 Hz, with each burst composed of 5 pulses at 100Hz.
  • fEPSPs slope was recorded for 60 or 120 min after LTP induction, and each slope value corresponding to an average of 8 responses of 20 s.
  • BDNF (20ng/ml) was perfused in the bath for 30 minutes. After BDNF 30 min incubation, LTP was induced in the second pathway (P1 electrode). LTP was quantified as the percentage of change in the average slope of the fEPSP.
  • FIG 8 shows that BDNF administration rescues absence seizures in vivo.
  • Adult (3-5 month old) male GAERS rats were anesthetized with 2-5% inhalation isoflurane and implanted with gold plated epidural screws (Svenska Dentorama AB, Sweden) (to record the electroencephalogram (EEG), which were positioned bilaterally in the frontal, temporal and cerebellar cortices.
  • EEG electroencephalogram
  • Two different groups of GAERS rats were also bilaterally implanted with guide cannulae in either the primary somatosensory cortex or the thalamic ventrobasal nucleus for the subsequent intracerebral injection of Artificial Cerebrospinal Fluid (ACSF) or BDNF.
  • ACSF Artificial Cerebrospinal Fluid
  • BDNF Since BDNF does not easily penetrate the brain following systemic administration, it was injected intraperitoneally 20 min after intravenous injection of Elacridar (Ela), a phosphoglycoprotein inhibitor (5mg/kg) which is known to increase the permeability of the blood-brain barrier (Kallen et al, 2012). BDNF was administered (at the time indicated by the arrow) at three different doses (1 ⁇ g/, 10 ⁇ g/ and 30 ⁇ g/animal) and its effect was recorded for 2 hours in freely moving GAERS rats previously implanted with EEG electrodes (Figure 8A). The results are presented in 20 min bins as data normalized to the control period, i.e. pre-BDNF injection.
  • Veh1 vehicle 1
  • Veh2 vehicle 2
  • Figure 8B vehicle 8B
  • Ela alone i.e. the group injected with Elacridar+Veh2
  • Ela alone had no effect on the total time spent in absence seizures (Figure 8B), as previously shown (Yacone et al., 2021).
  • the same lack of effect was observed when BDNF was injected alone without pre-treatment with Elacridar (i.e. the group injected with Veh1+BDNF 10 ⁇ g).
  • the smallest dose of BDNF (1 ⁇ g/rat) had no effect on the total time spent in absence seizures.
  • BDNF at 10 and 30 ⁇ g/rat markedly decreased the total time spent in seizures (Two-Way ANOVA, p ⁇ 0.01 and 0.001, respectively) during the entire course of the 2 hours of recordings after BDNF injection compared to the control period ( Figure 8B).
  • Some representative EEG traces showing the effect of BDNF on the SWDs following the illustrated injections are shown below the plot in Figure 8B.
  • BDNF bilaterally injected (at the time indicated by the arrow) in the thalamic ventrobasal nucleus of another group of freely moving rats also led to a decrease in the total time spent in seizures compared to administration of ACSF (Figure 8C, right panels). However, this effect took longer to develop (since it was first observed in the 60-80 min time bin) but reached the same percentage decrease as the intracortical injection 2 hour after BDNF injection.
  • Figure 9 shows that the anti-seizure effect of BDNF is mediated via TrkB-T1 receptors.
  • Cannulae were bilaterally lowered into the previously implanted guide-cannulae and ACSF injected via a micropump (at ??/min flow rate) either the primary somatosensory cortex or the thalamic ventrobasal nucleus. Following a 1-hour (control) period, the ACSF solution was changed to one containing BDNF (20ng/ml) and recording continued for another 2-hours (drug-effect period) (Figure 9A). EEG data were analysed using the SeizureDetect routine of SPIKE2 (Cambridge Electronic Design, Cambridge, UK) that allows automatic extraction of spike-and-wave discharges from the raw EEG data, as described by McCafferty e al. (2018).
  • TrkB-T1 agonists mitigate the neuropsychiatric comorbidities of absence seizures in vivo.
  • Figure 10 shows that BDNF rescues the deficiencies in novel object recognition observed in GAERS rats.
  • the Novel Object Recognition (NOR) test was performed in adult GAERS and NEC rats and in GAERS rats bilaterally injected (via a pre-implanted cannula) with ACSF or BDNF (500ng) in the CA1 regions of the hippocampus. The animals were handled for 5 days (10 min/day) and on day 6 were habituated to the open field twice, for 10 min each time.
  • mice were 1) placed in the maze with two similar objects for 5 minutes or 2) injected with 500ng/side of BDNF or ACSF and after 1h hour were placed in the maze and allowed to freely explore two similar objects for 5 minutes. Animal order, injection drug, object place and objects were randomized using the Excel randomization tool.
  • the test day one object was replaced with a novel object, and the animal was allowed to explore the objects for 5 min. Exploration of the object for less than 10 seconds was deemed to be an invalid trial. Higher time exploring novel object compared with similar object is a measure of intact memory (Ennaceur, 2010). The percentage of time exploring an object and the difference in time exploring the familiar and the novel object (i.e. the novelty index) were analysed.
  • Figure 11 shows that the BDNF-mediated rescue of the impaired LTP and deficient novel object recognition of GAERS rats occurs via TrkB-T1.
  • the methods of injection of siRNA viral construct, 3 weeks before the behavioural experiments) and the cannula implantation are similar to those described in Figure 8, except that cannulae were inserted bilaterally in the hippocampus.
  • the results are shown in Figure 11.
  • Hippocampal slices of GAERS rats pre-injected with a viral vector containing an astrocyte-selective (GFAP promoter) scramble siRNA for TrkB-T1 were used for LTP measurements in the presence of ACSF or BDNF.
  • GFAP promoter astrocyte-selective
  • GFAP promoter astrocyte-selective
  • TrkB-T1 agonists are efficacious agents against absence seizures and their comorbidities.
  • a single therapeutic agent e.g., a TrkB-T1 agonist
  • BDNF Brain- derived neurotrophic factor
  • GABA transporter-1 GABA transporter-1
  • ivabradine a hyperpolarization-activated cyclic nucleotide-gated channel inhibitor, blocks spontaneous absence seizures.
  • Crispr-Cas A Laboratory Manual, 1 st edition, 2016, Cold Spring Harbor Laboratory Press, New York, USA. Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition, 2013, American Psychiatric Association (APA), Washington D.C., USA. Handbook of Pharmaceutical Additives, 2 nd Edition, 2001, Endicott, New York, USA.

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  • Chemical Kinetics & Catalysis (AREA)
  • General Chemical & Material Sciences (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Organic Chemistry (AREA)
  • Medicines That Contain Protein Lipid Enzymes And Other Medicines (AREA)

Abstract

L'invention concerne de nouveaux agents thérapeutiques et leurs utilisations. L'invention concerne des méthodes de traitement d'absences épilectiques et/ou de leurs comorbidités, les méthodes comprenant l'administration d'un agoniste de TrkB-T1 à un sujet en ayant besoin. L'invention concerne également des procédés de criblage de composés tests pour l'activité d'agoniste de TrkB-T1.
PCT/EP2023/074506 2023-09-06 2023-09-06 Agoniste de trkb-t1 pour le traitement de l'absence épileptique et/ou de ses comorbidités Pending WO2025051360A1 (fr)

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WO1997003689A1 (fr) * 1995-07-14 1997-02-06 Amgen Inc. Procede de traitement de l'epilepsie au moyen du facteur neurotrophique derive du cerveau
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WO2016118741A1 (fr) * 2015-01-22 2016-07-28 Mitochon Pharmaceuticals Llc Expression induite du facteur neurotrophique dérivé du cerveau (bdnf) pour le traitement de maladies neuromusculaires, neurodégénératives, auto-immunes, liées au développement et/ou métaboliques

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