Technical field

The present disclosure concerns novel steroid compounds, the medical use thereof and in particular use in the treatment of diseases and disorders associated with an a3 subtype of the GABAA receptor, for example treatment of obesity, hyperphagia disorder, Prader-Willi’s syndrome, polycystic ovarian syndrome, and/or diabetes. Said disclosure is also concerned with reducing and/or preventing overweight. Additionally, related pharmaceutical and cosmetic compositions are disclosed.

Background

Gamma-aminobutyric acid (GABA) is the main inhibitory neurotransmitter in the central nervous system, and in the rest of the body acting on the GABAA and GABAB receptors.

The GABAA receptors are of several subtypes, located in different areas of the brain and are related to different CNS disorders and symptoms. Some GABAA receptors are localized within a synapse (intra-synaptic) while others are located outside a synapse (extra-synaptic). Some GABAA receptor modulating steroids can in physiological concentrations open the extra- synaptic GABAA receptor by themselves (tonic inhibition) but not the intra- synaptic receptors (phasic inhibition). These two types of effects are dependent on different mechanisms on the GABAA receptor and the effects depend in addition on the subunit composition of the receptor. In addition, positive GABAA receptor modulating steroids (GAMS) can enhance the effect of GABA in both extra and intrasynaptic receptors. The receptor subtype a4,p,b is an extra-synaptic subtype with both tonic and phasic effects when subjected to 3a-hydroxy steroids, such as 3a-hydroxy-5a/[3-pregnan-20-one/ol or 3ahydroxy- 5a/[3-androstan-17-one/ol. The GABA system plays an important role in many bodily functions, including the regulation of eating behavior. Many steroid-related CNS disorders or diseases and diabetes have been coupled to GABA signaling. The World Health Organization (WHO) have estimated that today nearly 2 billion adults worldwide, aged 18 years and older, are overweight. Obesity and overweight pose a major risk for chronic diseases, including type 2 diabetes, cardiovascular disease, hypertension and stroke, and certain forms of cancer. While energy balance is key to maintaining a healthy weight, genes are important in determining a person's susceptibility to weight gain.

Positive GABAA receptor modulating steroids (GAMS) are metabolites of the sex and stress hormones pregnanolone, progesterone, deoxycorticosterone, cortisone and cortisol, known as pregnanolones; as well as the metabolites of testosterone, androstanedione and dehydroepiandrosterone, known as androstanes. GAMS have been the subject of various studies, at least partially elucidating their role in the neurological signal system in mammals. These steroid metabolites induce CNS symptoms and disorders. They may share a 3a-hydroxy group, a 5a or 5|3 pregnane or androstane steroid body, or a double bond between carbon atoms 4 and 5 and a ketone or hydroxy group on position 17, 20 or 21. Examples of such steroids are 3a-hydroxy- 5a/[3-pregnan/54-pregnen-20-one/ol steroids or 3a-hydroxy-5a/[3- androstan/54-androsten-17-one/ol steroids, such as allopregnanolone, tetrahydrodeoxycorticosterone and androstanediol. Another example of a GAMS is tetrahydrodeoxycorticosterone (THDOC).

It was been shown that an abrupt reduction of food intake is seen after hampering GABAergic transmission. In animal studies, local application of GABAA-receptor agonists in key areas of feeding regulation in the brain has been shown to induce hyperphagia disorder. Excessive food intake is a well- known effect of GABAA receptor modulating steroids (GAMS). This has been shown in both animal and human studies. The a3 subtypes are known to regulate feeding, hunger, and satiety. In the brain, mainly the a3(33y2 receptor subtype is expressed.

As the 3a-hydroxy-pregnane/androstane steroids are endogenously produced and are metabolites of steroid hormones essential for life, their production cannot easily be interrupted. It was established previously that 3a- hydroxy-5a/[3 steroids may cause CNS disorders through the three possible mechanisms of a) direct action, b) tolerance induction, and/or c) withdrawal effect. These steroids are produced in high amounts during several days to years in specific disorders for example in obesity, hyperphagia disorder, Prader-Willi’s syndrome, polycystic ovarian syndrome, diabetes, during acute and chronic stress, the luteal phase of the menstrual cycle and during pregnancy. They are also continuously produced within the brain in high amounts at certain disorders. Their production is locally regulated. In certain disorder the specific receptor subtype is downregulated or not expressed at all. In such situations, the body compensates by expressing another receptor subtype. The a4,[3,5 receptor type is often then overexpressed. The a4,|3,5 receptor subtype is very sensitive to GAMS.

US5232917, US5925630, US5939545, US6143736 and US6277838 disclose a number of 3a-hydroxy steroids and 3|3 steroids. WO 99/45931 and WO 03/059357 disclose antagonistic effects of steroids. WO 08/063128 discloses a number of steroids, such as 3a-ethynyl-3[3-hydroxy-5a-androstan-17-oxime.

Wang et al. 2000 (Acta Physiol Scand 169, 333-341 ) and Wang et al. 2002 (J Neurosci 22(9):3366-75) discloses antagonistic effects of 3[3-hydroxy-5a- pregnan-20-one and other 3[3-hydroxy 5a/|3 pregnane steroids.

WO 09/142594 discloses 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one and teaches that this steroid has no effect as a GAMSA or GAMS (see table 3 in WO 09/142594). Many diseases and disorders are associated with GABAA receptor signalling and there is a large need in the field to identify specific modulators of GABA signal transduction, which modulate signalling via desired subtypes of GABAA receptors. In particular, as obesity and obesity related disorders are a large heath problem in the worlds, there is a great need to provide ways of treatment, alleviation and/or prevention of the obesity and obesity related disorders. It remains a challenge to suppress the effects on GAMS and obtain blockers thereof useful in therapy for example, in order to treat reduce the excessive food intake. Specific blockers, in particular blocker of a3 subunit of GABAA receptors, are therefore needed. In addition, it remains a challenge to find compounds that are physiologically safe and suitable for pharmaceutical use, and which additionally are applicable in physiologically acceptable doses with reasonable time intervals, for the treatment of said disorders.

Disclosure of the invention

It is an object of the present invention to provide compounds that reduce or at least partly overcome challenges in the prior art. It is an object of the present invention to provide novel compounds which have the ability to suppress GABA signalling and/or positive GABAA receptor modulating steroids (GAMS). In particular, the object of the present invention is to provide novel compounds which antagonizing GABA signaling via the a3 GABAA receptor subtype at least. An object is to provide such compounds which may be useful as medicaments and/or in non-therapeutic (in other words cosmetic) applications.

It is an object of the present invention to provide means for treatment, alleviation and/or prevention of a steroid-related CNS disorder or disease, an autoimmune disease and/or diabetes. Such steroid-related CNS disorder may for example be obesity, hyperphagia disorders and diseases or disorders associated with obesity or related to obesity. It is an object to provide means for reducing weight in a mammal by suppressing positive GABAA receptor modulating steroids (GAMS). In particular, it is an object to provide compounds useful in therapies to treat said disorders. It is also an object of the present invention to provide non-therapeutic treatments of overweight and overeating.

The present inventors have identified the novel the steroids compound 3a- ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1

3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2

(Formula 2)

The inventors show that 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a- ethyl-3[3-hydroxy-5a-androstan-17-one provide an antagonistic effect on GAMS enhancement of the a3 subtypes of the GABAA-receptor-chloride ionophore complex. Therefore, these compounds blocks the negative effects of GAMS. The compounds thereby acts as a GAMS antagonist (GAMSA). As such, the present inventors show that 3a-ethyl-3[3-hydroxy-5a-pregnan-20- one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one can be used in the treatment of GAMS-related and/or steroid-induced disorders or diseases of the central nervous system (CNS) as well as diabletes. These and other objects are achieved in full, or at least in part, by aspects of the inventive concepts as disclosed herein.

In a first aspect, there is provided compound selected from the group consisting of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1 , and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof, such as a pharmaceutically acceptable salt, hydrate or solvate thereof or a cosmetically acceptable salt, hydrate or solvate thereof. Thus the encompassed by the present disclosure are pharmaceutically acceptable salts, hydrates, prodrugs or solvates as well as cosmetically acceptable salts, hydrates, precursors or solvates of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and pharmaceutically acceptable salts, hydrates, prodrugs or solvates as well as cosmetically acceptable salts, hydrates, precursors or solvates of 3a-ethyl-3[3-hydroxy-5a- androstan-17-one.

In one embodiment, said compound is 3a-ethyl-3[3-hydroxy-5a-pregnan-20- one or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, such as pharmaceutically acceptable salt, hydrate or solvate thereof. In another embodiment said compound is 3a-ethyl-3[3-hydroxy-5a-pregnan- 20-one or a cosmetically acceptable salt, hydrate, precursor or solvate thereof, such as cosmetically acceptable salt, hydrate or solvate thereof.

In one embodiment, said compound is 3a-ethyl-3[3-hydroxy-5a-androstan-17- one, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, such as pharmaceutically acceptable salt, hydrate or solvate thereof. In another embodiment said compound is 3a-ethyl-3[3-hydroxy-5a-androstan- 17-one, or a cosmetically acceptable salt, hydrate, precursor or solvate thereof, such as cosmetically acceptable salt, hydrate or solvate thereof. The compounds disclosed herein exist as optical isomers and with deuterium or tritium instead of hydrogen; the invention encompasses compounds with all isotopes. In the synthesis of said compounds, individual isomers may need to be separated by chromatographic techniques and/or by other separations methods. Thus, in one particular embodiment, wherein said compound or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof comprises ³ H isotopes of hydrogen. In another embodiment, said compound or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof comprises ² H isotopes of hydrogen.

3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a- androstan-17-one may form salts which are within the scope of the present invention. Salts which are suitable for use in medicine are those wherein a counterion is pharmaceutically acceptable. Salts which are suitable for use in non-therapeutic uses are those wherein a counterion is cosmetically acceptable. The skilled person is aware of suitable salts for use in medicine and cosmetic applications. For example, suitable salts according to the invention include those formed with organic or inorganic acids or bases. In particular, suitable salts formed with acids according to the invention include those formed with mineral acids, strong organic carboxylic acids, such as alkanecarboxylic acids of 1 to 4 carbon atoms which are unsubstituted or substituted, for example, by halogen, such as saturated or unsaturated dicarboxylic acids, such as hydroxycarboxylic acids, such as amino acids, or with organic sulfonic acids, such as (Ci-C4)alkyl or aryl sulfonic acids which are unsubstituted or substituted, for example by halogen. Pharmaceutically and/or cosmetically acceptable acid addition salts include those formed from hydrochloric, hydrobromic, sulphuric, nitric, citric, tartaric, acetic, phosphoric, lactic, pyruvic, acetic, trifluoroacetic, succinic, perchloric, fumaric, maleic, glycolic, lactic, salicylic, oxaloacetic, methanesulfonic, ethanesulfonic, p- toluenesulfonic, formic, benzoic, malonic, naphthalene-2-sulfonic, benzenesulfonic, isethionic, ascorbic, malic, phthalic, aspartic, and glutamic acids, lysine and arginine.

Pharmaceutically and/or cosmetically acceptable base salts include ammonium salts, alkali metal salts, for example those of potassium and sodium, alkaline earth metal salts, for example those of calcium and magnesium, and salts with organic bases, for example dicyclohexylamine, N- methyl-D-glucamine, morpholine, thiomorpholine, piperidine, pyrrolidine, a mono, di- or tri lower alkylamine, for example ethyl, tertbutyl, diethyl, diisopropyl, triethyl, tributyl or dimethylpropylamine, or a mono- , di- or trihydroxy lower alkylamine, for example mono-, di- or triethanolamine. Corresponding internal salts may furthermore be formed.

In one embodiment, said pharmaceutically or cosmetically acceptable salt is a sodium salt. As apparent to a person of skill in the art, other salts may be equally suitable for the present compound. Non-limiting examples of other suitable salts are hydrochloride, sulfate, acetate, phosphate or diphosphate, chloride, potassium, maleate, calcium, citrate, mesylate, nitrate, tartrate and aluminum gluconate.

It should be understood that the compounds according to the present disclosure may be useful as a therapeutic agents in its own right. A direct therapeutic effect may for example be accomplished by provides an antagonistic effect on GAMS enhancement of a3 subtype(s) of the GABAA- receptor-chloride ionophore complex.

Thus, in a second aspect of the present there is provided a compound as disclosed herein for use as a medicament. Thus 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one, 3a-ethyl-3[3-hydroxy-5a-androstan-17-one or a pharmaceutically acceptable salt, hydrate, prodrug or solvate of either of said compounds may be used as a medicament.

As explained above, the present inventors show that 33a-ethyl-3[3-hydroxy- 5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one provide an antagonistic effect on GAMS enhancement of the a3 subtypes of the GABAA- receptor-chloride ionophore complexand thus acts acts as GAMS antagonists (GAMSA). Therefore, it is envisioned that the compounds may be used in the treatment of GAMS-related and/or steroid-induced disorders or diseases of the central nervous system (CNS) as well as diabetes. These and other objects are achieved in full, or at least in part, by aspects of the inventive concepts as disclosed herein.

Thus, in a third aspect of the present disclosure, there is provided a compound as disclosed herein, for use in prevention, alleviation and/or treatment of a steroid-related CNS disorder or disease, an autoimmune disease or of diabetes.

For the sake of clarity and avoidance of any doubt, as used herein in the context of therapeutic uses the terms “3a-ethyl-3[3-hydroxy-5a-pregnan-20- one” ,“3a-ethyl-3[3-hydroxy-5a-androstan-17-one”, “compound” and “compounds” are used interchangeably and are to be interpreted as encompassing 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3- hydroxy-5a-androstan-17-one and any pharmaceutically acceptable salt, hydrate, prodrug and/or solvate thereof.

Similarly, for the sake of clarity and avoidance of any doubt, as used herein in the context of non-therapeutic (in other words cosmetic) uses the terms “3a- ethyl-3[3-hydroxy-5a-pregnan-20-one” ,“3a-ethyl-3[3-hydroxy-5a-androstan-17- one”, “compound” and “compounds” are used interchangeably and are to be interpreted as encompassing 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one and any cosmetically acceptable salt, hydrate, precursor and/or solvate thereof.

As used herein, the terms 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and GR3047 are used interchangeably and refer to Formula 1 . As used herein, the terms 3a-ethyl-3[3-hydroxy-5a-androstan-17-one and GR3054 are used interchangeably and refer to Formula 2.

As used herein, the term “treatment” is used in the context of therapeutic treatment and relates to the treatment, such as causative or symptomatic treatment, of a disease or disorder, the alleviation of symptoms thereof and/or prevention of said disease or disorder. For example, it is envisioned that the obesity may be treated, alleviated or prevented by said treatment. For example, obesity may be a symptom of Prader-Willi’s syndrome and may as such be treated, alleviated or prevented by said treatment.

According to the present disclosure, a GAMS is any steroid that positively modulates the GABAA receptor. Typically, a positively modulating GAMS is a 3a-hydroxy-steroid. Non-limiting examples of such GAMS are 3a-hydroxy- 5a/[3-pregnan-20-one/ol, 3-a-hydroxy-5a/[3-androstan-17-one/ol and tetrahydrodeoxycorticosterone (THDOC, 3a-21 -dihydroxy-5a-pregnan-20- one).

Non-limiting examples of symptoms and conditions associated with or caused by the direct action of 3a-hydroxy-5a/[3-steroids are CNS disorders or diseases as follow: hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; and clumsiness.

Also envisioned is that said compounds may be useful in treatment of fatty liver, insulin resistance, autoimmune diseases, and inflammatory disorders and symptoms. In one embodiment, there is is provided a compound as disclosed herein, for use in prevention, alleviation and/or treatment of disorder o disease selected from the group consisting ot fatty liver, insulin resistance, autoimmune diseases, and inflammatory disorders and symptoms. In one embodiment, there is is provided a compound as disclosed herein, for use in prevention, alleviation and/or treatment of disorder o disease selected from the group consisting of fatty liver, insulin resistance, autoimmune diseases, and inflammatory disorders and symptoms and steroid-related CNS disorders. In one embodiment, there is is provided a compound as disclosed herein, for use in prevention, alleviation and/or treatment of disorder o disease selected from the group consisting of fatty liver, insulin resistance, autoimmune diseases, and inflammatory disorders and symptoms, diabetes and steroid-related CNS disorders. In one embodiment said use is in prevention, alleviation and/or treatment of a steroid-related CNS disorder. In one embodiment said use is in prevention, alleviation and/or treatment of diabetes. In one embodiment said use is in prevention, alleviation and/or treatment of autoimmune disease. In one embodiment said use is in prevention, alleviation and/or treatment of inflammatory disorders and symptoms.

The present inventors envision that the compound disclosed herein may be useful in the treatment of said diseases or disorders.

In recent years, a large body of scientific publication has shown that GABA signaling is also involved in the immune system and implicated disease of the immune system and in inflammation. It has become evident that cells of the immune system may also produce GABA and express GABAA receptors. These extra synaptic channels can be activated by low nano to micromolar GABA concentrations and such sub-micromolar GABA concentrations are present within the pancreas and in blood. The enzymes responsible for GABA synthesis and GABAA receptors have been detected in all immunological competent cells e.g., T cells, macrophages, dendritic cells, macrophages monocytes and furthermore, GABAergic action is involved in the interactions between antigen presenting cells and T cells, between T and B cells in adaptive immune responses, or cytotoxic NK- and T-cell responses. The realization that extra synaptic GABAA ion channels in immune cells can be fully activated by sub micromolar GABA concentrations makes GABA a potential effector molecule in many parts of the body including blood, pancreatic islets, cerebrospinal fluid and, of course, in the brain where the ambient GABA concentration is in the sub micromolar range. Research shows that mononuclear phagocytes and lymphocytes, dendritic cells, microglia, T cells and NK cells, express a GABAergic signaling machinery including membrane bound GABAA receptors. Mounting evidence shows that GABA receptor signaling impacts important immune functions, such as cell migration, cytokine secretion, immune cell activation and cytotoxic responses (Bhandage, - Barragan, 2021 ). Activation of GABA receptors on T cells and macrophages inhibits responses such as production of inflammatory cytokines. In T cells, GABA blocks the activation-induced calcium signal, and it also inhibits NF-KB activation. Furthermore, GABA clearly has an antiinflammatory action, which is associated with inhibition of NF-KB activation. NF-KB activation is also blocked in pancreatic [3 cells, which may be of considerable therapeutic importance because this pathway induces apoptosis in these cells. (Prud'homme et al., 2015).

The absence of a presynaptic terminal defines these channels in the immune cells as extra synaptic-like channels existing in the brain. Physiologically this seems reasonable as the local concentration will be at nano or picomolar GABA concentrations close to immune cells in the blood when they enter the brain or the pancreatic islets. There are significant differences between the GABAergic stimulation depending on the GABAA receptor subunit composition and therefore what subtypes are expressed in the immune cells. Properties like the affinity for GABA and the sensitivity to modulators’ such as the benzodiazepines and steroids determine the effect of modulators (Lindquist and Birnir 2006; Olsen and Sieghart 2009). It is, therefore, of great importance if the modulators are specific to a certain subunit composition. GABAA receptor subunit expression can be regulated with pharmacological agents (Uusi-Oukari, Korpi 2010).

Several studies have shown that GABA signalling may play a role in autoimmune disease and immune system related disease. For example, GABA ameliorates ongoing paralysis in experimental autoimmune encephalomyelitis (EAE) in mice models, by inhibiting onset of inflammation. GABA has also a role in rheumatoid arthritis and inflammatory responses to infection (Tian et al. 2011), autoimmune diseases like psoriasis, multiple sclerosis (Bath et al 2010), type I diabetes (Li et al 2017). Furthermore, the implication of GABA signaling in various autoimmune diseases, such as indicates a general role in inflammatory responses. In type 1 diabetes, GABA has been shown to have protective and stimulatory effects on [3 cells, but suppressive effects on the autoimmune response. (Prud'homme et al., 2015).

Thus, in one embodiment, there is provided said compound for use in the treament of steroid related CNS disorder or disease selected from the group consisiting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; obsessive compulsive disorder and clumsiness, such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; obsessive compulsive disorder and clumsiness, such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration and ADHD; such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome and menstrual cycle linked sleep disorders, such as the group consisiting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine and stress linked migraine, such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression, such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome and Alzheimer’s disease, such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder and worsening of Petit Mai epilepsy, such as the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder.

In one particular embodiment, said CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome and hyperphagia disorder associated with injury to the hypothalamus. In one particular embodiment, said CNS disorder or disease is selected from the group consisting of alcoholims; substance use disorder and relapses into alcohol and/or substance use disorder.

Table 1 A lists all receptor subtypes of the GABAA receptor. Table 1A.

GAMSAs with specificity to an a3-subtype GABAA receptor were unknown up to date. As shown in Table 1A, there are three known GABAA receptor a3 subtype, namely a3p3y2, a3[330 and a3p3s. The present inventors have found that when acting on the GABAA receptor a3 subtype, the compound disclosed herein are a partial antagonists to GABA and a full antagonist to 3a- hydroxy-pregnan/androstan-steroids. Exposure to a 3a-hydroxy- pregnan/androstane-steroid increases the chloride flux through the human GABAA receptor of any subtype but the compounds of the present disclosure inhibit the chloride flux through the human GABAA receptor a3 subtype. The effect is induced by GABA or induced by a 3a-hydroxy steroid combined with GABA. This has been tested in recombinantly expressed human embryonic kidney cells (HEK-cells) expressing the GABAA receptor a3(32y2 subtype, see the appended Examples (Example 1 ). Thus, in one embodiment, said a3 subtype of the GABAA receptor is a3(33y2. The inhibitory effect on GABAs effect is surprising since it was known to a person of skill in the art that similar compounds (having a 3[3-hydroxy configuration) have no antagonistic effect on GABA’s own abilty to open the receptor for flux of chloride ions. In prior art, similar compounds have either had no effect or have enhanced the effect of GABA and thus increased the chloride flux through the receptor (see for example US5,925,630).

Interestingly, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3- hydroxy-5a-androstan-17-one disclosed herein efficiently antagonize the GABAA receptor modulation effect of 3a-hydroxy-5a/[3-pregnan/androstane- steroids on the a3(33y2 GABAA receptor subtype. As such, it is envisioned that it is possible to selectively block the action of 3a-hydroxy-5a/[3- pregnan/androstane-steroids on the a3(33y2 GABAA receptor by simultaneous administration of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3- hydroxy-5a-androstan-17-one in pharmaceutically and physiologically acceptable amounts. Thereby, it is plausible that major advantages are achieved when the compound of the present invention is administrated while elevated doses of GAMS (either endogenous or administered) or increased sensitivity to GAMS are present in the body or CNS of a subject.

Without being bound by theory, it is envisioned that the selectively allows for administering a high dose when therapeutically motivated without the patient experiencing adverse side effects and/or allows for administering a low dose, for example during long term treatment, and still achieve a desired therapeutic outcome due to said selectivity.

Beneficially, this blocking may be achieved at pharmacologically and physiologically suitable concentrations as discussed in detail below. Thus, in one embodiment, there is provided the compound as disclosed herein for use in antagonizing GABA signaling via the a3p3y2 GABAA receptor subtype. In one embodiment of third aspect of the present disclosure, said CNS disorder or disease, autoimmune disease, or diabetes is associated with an a3 subtype of the GABAA receptor, such as the a3p2y2 subtype of the GABAA receptor.

In one embodiment of the present disclosure, there is provided the compound for use a disclosed herein, wherein steroid-related CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader- Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity;

Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder, such as group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome and hyperphagia disorder associated with injury to the hypothalamus.

In one embodiment said disease or disorder hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus and diabetes; such as the group consisting of hyperphagia disorder, obesity, Prader-Willi’s syndrome, polycystic ovarian syndrome, fatty liver, insulin resistance. and diabetes.

In one embodiment said disease or disorder hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus and diabetes; such as the group consisting of hyperphagia disorder, obesity, Prader-Willi’s syndrome, polycystic ovarian syndrome, and diabetes. In one embodiment, said disease is selected from the group consisting of obesity, hyperphagia disorder and Prader-Willi’s syndrome; or the group consisting of obesity, hyperphagia disorder and polycystic ovarian syndrome; or the group consisting of obesity, hyperphagia disorder and diabetes. In one embodiment, said disease is selected from obesity and hyperphagia disorder. In one embodiment, said disease is selected from obesity and diabetes. In one embodiment, said diabetes is diabetes type II. In one embodiment, said disease is selected from diabetes, fatty liver and insulin resistance. In one embodiment, said disease is fatty liver or insulin resistance.

Obese children as well as obese adults have been reported to have high blood concentrations of GAMS. Thus, in one embodiment, said disorder or disease is obesity.

Said obesity may be hypothalamic obesity. Hypothalamic obesity refers to obesity that is caused by physical or inborn damage to the hypothalamus (Rose et al., 2018). The hypothalamus is part of the brain that makes hormones that control specific body functions such as sleep, body temperature, and hunger. It also makes hormones that control other organs in the body, especially the pituitary gland. The symptoms of hypothalamic obesity vary by the cause and include uncontrollable hunger, rapid, excessive weight gain, and a low metabolic rate. If the pituitary gland is involved, symptoms may include small underdeveloped testes in males and delayed puberty. This condition most often occurs because of injury to the hypothalamus due to a tumor, swelling in the brain, brain surgery, or head trauma. The diagnosis is made by physical examination and review of the symptoms. There is no cure for hypothalamic obesity. At present, treatment involves a combination of surgery, medications, and nutritional and lifestyle counseling. The long-term outlook for people with this condition is dependent on weight loss and management.

Hyperphagia disorder relates to an abnormally great desire for food and/or excessive eating. Non-limiting examples of hyperphagia disorder comprise binge eating disorder, hyperphagia disorder associated with injury to the hypothalamus, and Prader-Willi’s syndrome. A patient suffering from binge eating disorder suffers from recurrent episodes of eating large quantities of food and a feeling of loss of control. In one embodiment, said disease or disorder is a hyperphagia disorder, such as hyperphagia disorder resulting in overweight and/or obesity. In one embodiment, said hyperphagia disorder is binge eating disorder or hyperphagia disorder associated with injury to the hypothalamus.

For maintaining health, energy intake should normally be in balance with energy expenditure. For example, in the group of moderately active adults at age 66 or older, men are advised to eat about 2200 kilo calories per day and women are advised to eat about 1800 kilo calories per day. To avoid unhealthy weight gain, total fat should not exceed 30 % of total energy intake. Intake of saturated fats should be less than 10 % of total energy intake, and intake of trans-fats less than 1 % of total energy intake, with a shift in fat consumption away from saturated fats and trans-fats to unsaturated fats, and towards the goal of eliminating industrially-produced trans-fats. In one embodiment, said hyperphagia disorder comprises eating at least 105 % of the individual’s energy expenditure, such as 110 % of an individual’s energy expenditure, such as 115 % of an individual’s energy expenditure, such as 120 % of an individual’s energy expenditure, such as 125 % of an individual’s energy expenditure, such as 130 % of an individual’s energy expenditure, such as 135 % of an individual’s energy expenditure, such as 140 % of an individual’s energy expenditure, such as 145 % of an individual’s energy expenditure, such as 150 % of an individual’s energy expenditure, such as 155 % of an individual’s energy expenditure, such as 160 % of an individual’s energy expenditure, such as 165 % of an individual’s energy expenditure, such as 170 % of an individual’s energy expenditure, such as 175 % of an individual’s energy expenditure, such as 180 % of an individual’s energy expenditure, such as 185 % of an individual’s energy expenditure, such as 190 % of an individual’s energy expenditure, such as 195 % of an individual’s energy expenditure, such as 200 % of an individual’s energy expenditure, such as 210 % of an individual’s energy expenditure, such as 220 % of an individual’s energy expenditure, such as 230 % of an individual’s energy expenditure, such as 240 % of an individual’s energy expenditure, such as 250 % of an individual’s energy expenditure, such as 260 % of an individual’s energy expenditure, such as 270 % of an individual’s energy expenditure, such as 280 % of an individual’s energy expenditure, such as 290 % of an individual’s energy expenditure, such as 300 % of an individual’s energy expenditure.

People suffering from Prader-Willi’s syndrome have problems with hyperphagia disorder from young age and often become overweight or even obese already during the teenage years. These subjects typically exhibit an over expression of GABAA receptor subunits that are highly sensitive to GAMS. Thus, in one embodiment, said disease or disorder is Prader-Willi’s syndrome. In one embodiment, said disease is Prader-Willi’s syndrome resulting in overweight and/or obesity. In other words, overweight and/or obesity associated with Prader-Willi’s syndrome may be treated.

Women with PolyCystic Ovarian Syndrome (PCOS) have also been reported to exhibit high levels of GAMS. In one embodiment, said disease is polycystic ovarian syndrome. Over 60 % of the women with this disorder are obese or overweight. Therefore, in one embodiment, said disease or disorder is polycystic ovarian syndrome, such as polycystic ovarian syndrome resulting in overweight and/or obesity. In another embodiment, said disease is obesity associated with to polycystic ovarian syndrome. In other words, overweight and/or obesity associated with polycystic ovarian syndrome may be treated.

Modulators of the GABAA receptor can affect the insulin production, immunological functions and insulin resistance in diabetes type II (Tian et al., Prud'homme et al.) Thus, in a related embodiment, said disease is obesity associated with diabetes. In one related embodiment, said diabetes is diabetes type II. In one embodiment, disease is fatty liver or insulin resistance.

Additionally, obesity and/or hyperphagia disorder may increase the risk for developing type II diabetes. Obesity and diabetes type II are a common comorbidity. In one embodiment, said diabetes is associated with overweight and/or obesity. Obesity and diabetes type II are a common comorbidity. In one embodiment, said diabetes is associated with overweight and/or obesity.

In yet another embodiment, said disease is an autoimmune disease. In one embodiment, said autoimmune disease may be diabetes type I. Obesity in diabetes type I is a disadvantage since it may be harder to control the diabetes and maintain insulin at healthy levels. For example, if it is hard to control the intake of food it will be hard to control the dosing of insulin. This may lead to an elevated probability to reach a hypoglycemic state.

In yet another embodiment, said disease is an inflammatory disorder and/or symptom.

The GABA-system is involved in diseases such as alcoholism and drug abuse. Modulators of the GABAA receptor can affect the urge of abusing alcohol and/or substances. In this context, the substance may is any substance whose ingestion can result in a euphoric ("high") feeling. In one embodiment, wherein said CNS disorder or disease is alcoholism, substance use disorder or relapse into alcoholism and/or substance abuse disorder. In one embodiment said disease or disorder is alcoholism. In one embodiment, said disease or disorder is substance use disorder.

As used herein the term, “drug use disorder” or “substance use disorder”, refers to a a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medication. Substances such as marijuana and nicotine also are considered drugs.

As used herein, the terms “alcoholism” and “alcoholism use disorder” are used interchangably. The GABA system may be involved in the pathophysiology of obsessive- compulsive disorder. In one embodiment, said disease is obsessive- compulsive disorder.

Without being bound by theory, it is envisioned that the compounds as disclosed herein may be useful to selectively block the action of 3a-hydroxy- 5a/[3-pregnan/androstane-steroids on the a3j33y2 GABAA receptor. As discussed above, it is plausible that major advantages are achieved when the one or both compounds of the present invention are administrated while elevated doses of GAMS (either endogenous or administered) or increased sensitivity to GAMS are present in the body or CNS of a subject. Thus, it is envisionend that the compound may be useful in prevention, alleviation and/or treatment of a condition caused by exposure to at least one 3a- hydroxy-steroid endogenous or exogenous. In one particular embodiment, the are provided the compounds as disclosed herein for use in prevention, alleviation and/or treatment of a side effect caused by an anti-inflammatory steroid, postmenopausal therapy, and/or an oral contraceptive. Said side effect may be caused by elevated levels of 3a-hydroxy-5a/[3- pregnan/androstane-steroids.

It is envisioned that the administration of 3a-ethyl-3[3-hydroxy-5a-pregnan-20- one, 3a-ethyl-3[3-hydroxy-5a-androstan-17-one or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof leads to a decrease of bodyweight. For example, the decrease in bodyweight may be seen after 1 to 100 days, such as 2 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days. Thus, in one embodiment said treatment results in a decrease in bodyweight after 1 to 100 days, such as 2 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days, of treatment. In one particular embodiment, said treatment results in a decrease of daily calory intake by at least about 10 %, such as at least 15 %, such as at least 20 %, such as at least 25 %, such as at least 30 %, such as at least 35 %, such as at least 40 %, such as at least 45 %, such as at least 50 %. According to the present disclosure, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one may be administered by one of the following routes of administration: intravenously, nasally, per rectum, intravaginally, percutaneously, subcutaneously, transdermally, intramuscularly, or orally. In one embodiment, said 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one is administered by a route of administration selected from the group consisting of intravenous, nasal, per rectum, intravaginal, percutaneous, subcutaneous, transdermal, intramuscular and oral administration; such as the group consisting of nasal, per rectum, intravaginal, subcutaneous, transdermal, intramuscular and oral administration; such as the group consisting of nasal, subcutaneous, transdermal and oral administration. In one embodiment, said route of administration is selected from the group consisting of nasal, per rectum, intravaginal, percutaneous, subcutaneous, transdermal, intramuscular and oral administration; such as the group consisting of nasal, percutaneous, subcutaneous, transdermal and oral administration. In one embodiment, said route of administration is selected from the group consisting of nasal, oral and subcutaneous administration or nasal, oral and percutaneous administration. According to one embodiment, 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one is administered intravenously.

It is considered that ways of administration which are simple and easy for the patient, causing minimal discomfort if any, are desirable and also increase patient compliance with treatment. Nasal administration is envisioned as a promising administration alterative, as it offers the benefits of ease and the possibility of self-administration by a patient. Similarly, oral administration is envisioned as a promising administration alternative also allowing for selfadministration without assistance of others. Thus, according to another embodiment, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3- hydroxy-5a-androstan-17-one is administered nasally. In one embodiment, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a- androstan-17-one is administered orally.

Self-administration has the advantage of allowing a patient to adjust the dose or the frequency of medication either according to a subjective evaluation of their condition or according to a schedule prescribed by a treating physician. The term “schedule prescribed by the treating physician” includes the alternative where a patient makes a subjective evaluation of his/her condition, either unaided or aided by a questionnaire or a range or scale, or using an algorithm or a computer program, indicating the suitable next dose. Percutaneous administration, using 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one formulated as a cream, a gel, and an ointment or in the form of slow-release adhesive medicine patches, is another possible form of administration, similarly suitable for self- medication. The advantages of self-administration listed above apply also to percutaneous administration, with the added advantage that the administration can easily be interrupted if desired or necessary, e.g. by removing the medicine patch.

It is also possible that administration is via a depot formulation, which releases an effective amount of the therapeutically active compound as disclosed herein, over a period of time. The skilled person will appreciate that the depot formulation may be adapted to deliver the desired effective dose as prescribed by a treating physician. A depot formulation may be a subcutaneous depot formulation. Thus, in one embodiment, said administration via a depot formulation, such as a subcutaneous depot formulation.

In any of these or other routes of administration, the formulation of the composition may be adapted or adjusted according to normal pharmacological procedures, comprising the effective pharmaceutical in a chemical form, suitable for the chosen route, together with suitable excipients, such as adjuvants, carriers, diluents and vehicles, conventionally used and well-known to a person skilled in the art. Conventionally used adjuvants and vehicles for oral administration are for example fillers or suspending agents like titanium dioxide, lactose anhydride, silica, silica colloidalis, methylcellulose, magnesium stearate, microcrystalline cellulose and the like. As used herein, the term “adjuvant” relates to a compound which potentiates the effect of the pharmaceutically active compound.

Conventionally used excipients for intravenous administration are for example sterile water for injections (WFI), sterile buffers (for example buffering the solution to pH 7.4) albumin solution, lipid solutions, cyclodextrin and variants thereof, and the like.

Conventionally used excipients for subcutaneous administration are for example sterile water for injections (WFI), sterile buffers (for example buffering the solution to pH 7.4) lipid solutions, cyclodextrins and the like. Conventionally used excipients for subcutaneous administration via a subcutaneous delivery system, such as a subcutaneous rod, are for example sterile water for injections (WFI), sterile buffers (for example buffering the solution to pH 7.4) lipid solutions, cyclodextrins and the like.

Conventionally used excipients for transdermal and/or subcutanous administration are for example vaseline, liquid paraffin, glycerol, water, MCT oil, sesame oil and the like.

The skilled person will appreciate that the suitable dose will naturally vary depending on the mode of administration, the particular condition to be treated or the effect desired, gender, age, weight and health of the patient, as well as possibly other factors, evaluated by the treating physician. According to the present disclosure, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a- ethyl-3[3-hydroxy-5a-androstan-17-one may be administered intravenously, a suitable dose may be that ranging from about 0.1 to about 300 mg per kg body weight. Preliminary studies in animals indicate that a preferred dose interval for intravenous administration is from about 20 to about 100 mg per kg body weight. In one embodiment, said compound is administrated in an effective dose in the range of from about 0.1 to about 300 mg per kg body weight, such as in a dose in the range of from about 0.2 to about 200 mg per kg body weight, such as in a dose in the range of from about 0.3 to about 150 mg, such as in a dose in the range of from about 0.4 to about 150 mg per kg bodyweight, such as in a dose in the range of from about 0.5 to about 120 mg per kg bodyweight, such as in a dose in the range of from about 1 to about 100 mg per kg body weight, such as in a dose in the range of from about 1 to about 50 mg per kg body weight, such as in a dose in the range of from about 1 to about 5 mg per kg body weight, such as about 1 mg per kg body weight. It is envisioned that a therapeutically effective concentration of 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one may be in the range of from about 10 mg/day to about 30 g/day, such as of about 20 mg/day to about 20 g/day. In one embodiment, said compound is administrated in a dose in the range of from about 30 mg to about 15 g/day, such as in an effective dose in the range of from about 40 mg/day to about 15 g day, such as in a dose in the range of from about 50 mg/day to about 12 g/day, such as in a dose in the range of from about 100 mg/day to about 10 g/day, such as in a dose in the range of from about 100 mg/day to about 5 g/day, such as in a dose in the range of from about 100 mg/day to about 500 mg/day. In one embodiment, said compound is administrated in a dose in the range of from about 20 mg/day to about 60 g/day, such as in a dose in the range of from about 40 mg/day to about 40 g/day, such as in a dose in the range of from about 60 mg/day to about 30 g/day, such as in a dose in the range of from about 80 mg/day to about 30 g/day, such as in a dose in the range of from about 100 mg/day to about 24 g/day, such as in a dose in the range of from about 200 mg/day to about 20 g/day, such as in a dose in the range of from about 200 mg/day to about 10 g/day, such as in a dose in the range of from about 200 mg/day to about 1 g/day.

Said above mentioned doses are to be understood to refer to therapeutically effective doses.

As apparent to a person of skill in the art, 3a-ethyl-3[3-hydroxy-5a-pregnan- 20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one may be administered at one or more occasions per day. In one embodiment, 3a-ethyl- 3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17- one is administered once per day. In another embodiment, 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one is administered twice per day, or even three or four times per day. It may be suitable that the administration is in connection with meals, such as the three main meals of the day (for example breakfast, lunch and dinner or other meal schedule which is relevant and suitable for the patient, for example a more frequent meal schedule). It may also be suitable that the compound of the invention is administrated less frequently, such as every second day, or every third day, or even once every week. In embodiments where the compound of the present disclosure is administrated as a subcutaneous implant or depot, the administration of the compound is a continuous process under diffusion. Such implant or depot may be inserted to a patient and may last for at least one month, such as for at least six months, such as for at least one year, such at least for two years, such as for at least three years, such as for at least four years, such as for at least five years, such as for at least six years. In one embodiment, wherein the compound is administrated as a subcutaneous implant or depot, it may be beneficial that the daily dose of is constant over a desired therapeutic period. The daily dose administered may be as discussed in the section above and is not repeated here for the sake of brevity.

In one embodiment, said compound as disclosed herein or compound for use as disclosed herein provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) and/or the effect of any GABAA receptor modulating steroids (GAMS) on a GABAA receptor a3 subtype, such as on the GABAA receptor O3[32Y2 subtype. In one embodiment, said compound or compound for use as disclosed herein provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) on said GABAA receptor a3 subtype. In another embodiment, said compound or compound for use as disclosed herein provides an antagonistic effect on the effect of any GABAA receptor modulating steroids (GAMS) on said GABAA receptor a3 subtype, for example on the effect of THDOC.

As described above, GABA is the main inhibitory neurotransmitter in the central nervous system, and in the rest of the body. Therefore, it is envisioned, without being bound by theory, that a 100 % antagonistic effect of GABA may give rise to serious side effects. As such, said antagonistic effect achieved by the compound as disclosed herein is preferably a partial antagonistic effect. Thus, in one embodiment the antagonistic effect of said compound on GABA signaling via the a3 subtype GABAA receptor is least 1 %, such as at least 2 %, such as at least 3 %, such as at least 4 %, such as at least 5 %, such as at least 10 %, such as at least 15 %, such as at least 20 %, such as at least 25 %, such as at least 30 %, such as at least 35 %, such as at least 40 %, such as at least 45 %, such as at about 50 %.

Preferably, said partial antagonistic effect is at most 80 %, such as at most 75 %, such as at most 70 %, such as at most 65 %, such as at most 60 %, such as at most 55 %, such as at most 50 %.

Thus, in one embodiment said compound antagonizes GABA signaling via the a3 subtype GABAA receptor by at most 80 %, such as at most 75 %, such as at most 70 %, such as at most 65 %, such as at most 60 %, such as at most 55 %, such as at most 50 %.

For clarity, an antagonistic effect of 70 % is to be interpreted as that 30 % activity still remains.

The skilled person will appreciate that the compound for use as disclosed herein may be administered at a dose which achieves said partial antagonistic effect.

As discussed above, said compound provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on an a3 subtype of the GABAA receptor, such as the C(3|32Y2 subtype of the GABAA receptor. In one embodiment, said compound for use as disclosed herein further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype.

As discussed above, said compound provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on an a3 subtype of the GABAA receptor, such as the O3|32Y2 subtype of the GABAA receptor. In one embodiment, said compound for use as disclosed herein further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype, such as the a2, a4 and/or a5 subtype. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3 and a1 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3 and a2 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3, a2 and a1 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3, a2 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3, a1 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3, a2 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3, a2 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a3, a4 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a3 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a3 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a3, a4 and a5 subtypes.

As discussed above, said compound provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on an a3 subtype of the GABAA receptor, such as the a3p2y2 subtype of the GABAA receptor.

In one embodiment, said compound for use as disclosed herein further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a1 , a2, a4 and/or a5 subtype, such as the a2, a4 and/or a5 subtype. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3 and a1 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3 and a2 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) on the GABAA receptor a3 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) on the GABAA receptor a3, a2 and a1 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of v-aminobutyric acid (GABA) on the GABAA receptor a3, a2 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3, a1 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) on the GABAA receptor a3, a2 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3, a2 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3, a4 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of v-aminobutyric acid (GABA) on the GABAA receptor a1 , a2, a3 and a4 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) on the GABAA receptor a1 , a2, a3 and a5 subtypes. In one embodiment, said compound further provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a1 , a3, a4 and a5 subtypes.

The level or degree of the antagonistic effect of said compound on GABA signaling via the a1 , a2, a4 and/or a5 subtype(s) of the GABAA receptor may differ from the same antagonistic effect via the a3 subtype of the GABAA receptor, such as the a3(32y2 subtype of the GABAA receptor. Thus, in one embodiment the antagonistic effect of said compound on GABA signaling via the a1 , a2, a4 and/or a5 subtype GABAA receptor is within the range of 1-30 %, such as within the range of 2-25 %, such as within the range of 3-22 %, such as within the range of 4-20 %, such as within the range of 5-15 %, such as within the range of 7-13 %, such as within the range of 8-10 %. It will be understood that said ranges are equally relevant for any one of said further provided antagonistic effects on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on individual or subsets of GABAA receptor subtypes (see above).

The present inventors have shown that 3a-ethyl-3[3-hydroxy-5a-pregnan-20- one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one provide unique effect on the different GABAA receptor subtypes, compared to other similar known steroid ligands for this receptor. Furthermore, 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one also provide a unique effect on GAMS effect on GABAA receptor subtypes, such as GAMS effect on the a3 subtype.

It will be appreciated that the GAMS antagonist described herein may form part of a pharmaceutical composition. Thus, in a fourth aspect, there is provided a pharmaceutical composition comprising 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17-one as described herein, and at least one pharmaceutically acceptable excipient(s).

As used herein, the term “excipient” encompasses adjuvants, carriers, diluents, and vehicles. The skilled person appreciates that any adjuvants, carriers, diluents and vehicles mentioned in connection with the first aspect as disclosed herein are suitable in said pharmaceutical composition and it is withing the knowledge of the skilled person to make the appropriate choice thereof. The skilled person appreciates that the pharmaceutical composition may be adapted to be suitable for the selected administration route as well as desired administered dose. Relevant doses and administration routes are disclosed in connection to the third aspect above. Non-limiting examples of suitable carriers are cyclodextrin, sterile water for injections (WFI), sterile buffers (for example buffering the solution to pH 7.4) albumin solution, lipid solutions, cyclodextrin variants and the like.

In a related fifth aspect, there is provided a method of treatment, alleviation and/or prevention of a steroid-related CNS disorder or disease, an autoimmune disease, or of diabetes, comprising the step of administering a pharmaceutically effective amount of comprising administering a pharmaceutically effective amount of compound selected from the group consisting of

3a-ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1

3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2 a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, to a patient in need thereof as disclosed herein or a pharmaceutical composition as disclosed herein, to a patient in need thereof. It will be appreciated that the embodiments disclosed in connection with the third aspect, including embodiments related to dose, frequency of administration and route of administration, are equally relevant for this fiftth aspect as for aspects three and four and are not repeated here merely for the sake of brevity.

The CNS disorder or disease or diabetes may be associated with an a3 subtype of the GABAA receptor, such as the a3(32y2 subtype of the GABAA receptor. For example, said steroid-related CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader- Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; and clumsiness.

In particular, the disease or disorder may be selected from the group consisting of a steroid-related CNS disorder or disease and diabetes. In particular, said disorder may be selected fro the group consisint of hyperphagia disorder; obesity; Prader-Willi’s syndrome; and polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes, pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism, substance use disorder; relapses into alcohol and/or substance use disorder and diabetes, such as the group consisint of hyperphagia disorder; obesity; Prader-Willi’s syndrome; and polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes, pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism, substance use disorder; relapses into alcohol and/or substance use disorder. In particular, the disease may be a disease selected from the group consisting of obesity, hyperphagia disorder, Prader- Willi’s syndrome, polycystic ovarian syndrome, and diabetes. The disease may be Prader-Willi’s syndrome. The disease may be polycystic ovarian syndrome, resulting in overweight or obesity. The disease may be diabetes, resulting in overweight or obesity. The disease may be obesity. The disease may be hyperphagia disorder. The disease may be alcoholims. The disease may be substance use disorder.

As explained above, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl- 3[3-hydroxy-5a-androstan-17-one may be in the form of a compound or a pharmaceutically acceptable salt thereof. In one embodiment of the fifth aspect, said compound is in the form of a sodium salt. Other salts apparent to a person of skill in the art are also plausible as disclosed in connection with the first aspect.

Additionally, there is provided a method of treating, alleviating and/or preventing a condition caused by exposure to at least one 3a-hydroxy-steroid, comprising administering a pharmaceutically effective amount of compound as disclosed herein, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, to a patient in need thereof. Said exposure may be to an endogenous or exogenous 3a-hydroxy-steroid.

Additionally, there is provided a method of treating, alleviating and/or preventing a side effect caused by an anti-inflammatory steroid, postmenopausal therapy, and/or an oral contraceptive, comprising administering a pharmaceutically effective amount of compound as defined herein, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, to a patient in need thereof.

In one embodiment, the method of treatment, alleviation and/or prevention as disclosed herein results in a decrease of bodyweight. Plausibly, a decrease in bodyweight may be seen after 1 to 100 days, such as 2 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days. In one embodiment, said method results in a decrease of daily calory intake by at least about 10 %, such as at least 15 %, such as at least 20 %, such as at least 25 %, such as at least 30 %, such as at least 35 %, such as at least 40 %, such as at least 45 %, such as at least 50 %.

In one particular embodiment, there is provided a method as dislclosed herein, wherein said compound is administrated intravenously, nasally, per rectum, intravaginally, percutaneously, intramuscularly, or orally. In one embodiment, said administration is oral or nasal administration.

As discussed in detail in connection with the third aspect as disclosed herein, the compound as disclosed herein may be administrated in a dose of from about 0.1 to about 300 mg per kg body weight from about 0.2 to about 200 mg per kg body weight, such as a dose of from about 0.3 to about 150 mg, such as about 0.4 to about 150 mg per kg bodyweight, such as about 0.5 to about 120 mg per kg bodyweight, such as from about 1 to about 100 mg per kg body weight, such as from about 1 to about 50 mg per kg body weight, such from about 1 to about 5 mg per kg body weight, such as about 1 mg per kg body weight. In particular, said compound may be administrated at about 0.2 to about 200 mg per kg body weight.

As discussed in detail with the context of the third aspect and not repeated here for the sake of brevity, the compound of the present disclosure may provide an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA- receptor a3 subtype(s). Thus, in one embodiment, there is provided a method as disclosed herein, wherein said compound provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA-receptor a3 subtype(s). In one embodiment, said antagonistic effect is on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a3 subtype(s) or a on the effect of any GABAA receptor modulating steroids (GAMS) on the GABAA-receptor a3 subtype(s). Additionally, said compound may further provide an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype(s).

According to a sixth aspect of the invention, there is provided use of 3a-ethyl- 3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3-hydroxy-5a-androstan-17- one or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, for the manufacture of a medicament for the prevention, alleviation and/or treatment steroid-related CNS disease or disorder, an autoimmune disease, and diabetes, for example a disease or disorder associated with an a3 subtype of the GABAA receptor. In this aspect of the invention, the corresponding embodiments of the third aspect, are applicable and are not repeated here merely for the sake of brevity. In particular, the disease or disorder may be selected from the group consisting of a CNS disorder or disease, an autoimmune disease, or diabetes that is associated with an a3 subtype of the GABAA receptor, such as the a3(32y2 subtype of the GABAA receptor.

In particular, said CNS disease or disorder may be selected from the group consisint of hyperphagia disorder; obesity; Prader-Willi’s syndrome; and polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes, pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism, substance use disorder; relapses into alcohol and/or substance use disorder and diabetes, such as the group consisint of hyperphagia disorder; obesity; Prader-Willi’s syndrome; and polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes, pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism, substance use disorder; relapses into alcohol and/or substance use disorder.

In particular, the disease or disorder may be a disease selected from the group consisting of obesity, hyperphagia disorder, Prader-Willi’s syndrome, polycystic ovarian syndrome, and diabetes. The disease may be Prader- Willi’s syndrome. The disease or disorder may be polycystic ovarian syndrome, resulting in overweight or obesity. The disease or disorder may be diabetes, resulting in overweight or obesity. The disease or disorder may be obesity. The disease or disorder may be hyperphagia disorder.

The compounds as disclosed herein may also be useful for cosmetic applications. Thus, in a seventh aspect of the present disclosure, there is provided a use a compound selected from the group consiting of 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one according to Formula 1 and 3a-ethyl-3[3-hydroxy- 5a-androstan-17-one according to Formula 2, or a cosmetically acceptable salt, hydrate, precursor or solvate thereof, for non-medical reduction and/or prevention of overweight in a subject. Thus, said use in a non-therapeutic use and may also be referred to a cosmetic use. The skilled person appreciates that the terms non-medical, non-therapeutic and cosmetic are synonymous in this context and exclude medical uses which include treatment and/or preventions of pathological conditions. The compound can also be a precursor, which is transformed into 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one or into 3a-ethyl-3[3-hydroxy-5a-androstan-17-one in the body of a subject, similarly to a prodrug. It is envisioned that prevention of overweight comprises reducing calory intake. For example, reduction of calory intake by at least about 10 %, such as at least 15 %, such as at least 20 %, such as at least 25 %, such as at least 30 %, such as at least 35 %, such as at least 40 %, such as at least 45 %, such as at least 50 %.

To clarify, said non-medical use relates to reduction or prevention in subjects who have a BMI of less than 30. Thus, in one embodiment, said reduction and/or prevention of overweight is in a subject who has a BMI<30.

In one embodiment, said use relates to prevention of overweight in a subject who has a BMI below 25, and optionally who wishes to maintain a BMI in the range of from about 18.5 to 24.9.

In one embodiment, said use relates to reduction of overweight in a subject who has a BMI in the range of 25 to 29.9, and optionally who wishes to reduce the BMI to the range of from about 18.5 to 24.9.

The skilled person will appreciate that said compound may be administrated at a dose as disclosed in connection with the third aspect is equally applicable and is not repeated here for the sake of brevity. Similarly, the administration occasions disclosed in connection with the third aspect are also applicable here.

The present inventors envision a use of a composition comprising the compound as disclosed herein, wherein said composition is a cosmetic composition. Thus, there is provided a use of a cosmetic composition comprising 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl-3[3- hydroxy-5a-androstan-17-one and at least one cosmetically acceptable excipient. The skilled person will appreciate the excipients disclosed in connection with the second aspect, relating to the pharmaceutical composition, also are applicable to the cosmetic composition and are not repeated here for the sake of brevity. Thus, said excipient are considered cosmetically acceptable excipients. Additionally, the skilled person is aware of other suitable cosmetic acceptable excipients.

The skilled person will appreciate that said compound may be administrated at a dose as disclosed in connection with the third aspect is equally applicable and is not repeated here for the sake of brevity. For clarity, thus said doses are considered cosmetically effective doses. However, in particular, it is envisioned that said 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and/or 3a-ethyl- 3[3-hydroxy-5a-androstan-17-one is administered by a route of administration selected from the group consisting of nasal, percutaneous, subcutaneous, transdermal, and oral administration may be suitable administration routes. In one embodiment, said route of administration selected from the group consisting of nasal, transdermal, and oral administration. In one embodiment, said route of administration is oral administration.

It is envisioned that said use will lead to the decrease in bodyweight which may be seen after 1 to 100 days, such as 2 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days. Thus, in one embodiment use results in a decrease in bodyweight after 1 to 100 days, such as 2 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days, of treatment. In one particular embodiment, said use results in a decrease of daily calory intake by at least about 10 %, such as at least 15 %, such as at least 20 %, such as at least 25 %, such as at least 30 %, such as at least 35 %, such as at least 40 %, such as at least 45 %, such as at least 50 %.

In a related aspect, there is provided a cosmetic, non-therapeutic method of preventing or reducing overweight in a subject comprising administering a cosmetically effective amount of a compound selected from the group consiting of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one according to Formula 1 and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one according to Formula 2, or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

In one embodiment, there is provided said cosmetic, non-therapeutic method, wherein said prevention or reduction of overweight is in a subject having a BMI<30. In one embodiment, there is provided said cosmetic, non-therapeutic method, wherein said overweight is defined as a BMI in the range of 25-29.9. In one embodiment of said cosmetic, non-therapeutic method, a decrease in bodyweight is seen after 1 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days. The skilled person appreciates that embodiments disclosed in the context of the seventh aspect above are also applicable to the cosmetic, non-therapeutic method as disclosed herein. In an eight aspect, there is provided a cosmetic composition comprising a cosmetically effective amount of a compound selected from the group consisting of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1 and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2 or a cosmetically acceptable salt, hydrate, precursor or solvate thereof and at least one cosmetically acceptable excipient. In one particular embodiment, said compound is 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

In another embodiment, said compound is 3a-ethyl-3[3-hydroxy-5a-androstan- 17-one or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

It is envisioned that said composition may comprise both said compounds. Acceptable excipients are discussed in detail in the context of the third aspect and are not repeated there for the sake of brevity. The cosmetic composition may be formulated for a route of administration selected from the group consisting of nasal, percutaneous, subcutaneous, transdermal, and oral administration, in particular group consisting of nasal, transdermal, and oral administration as discussed above. In one embodiment, said cosmetic composition is formulated for oral or nasal administration.

It is noted that, as used in this specification and the appended claims, the singular forms “a”, “an”, and “the” also include plural referents unless the context clearly dictates otherwise.

The term “blocking” is meant to define an effect where in this case GABA or the 3a-hydroxy-5a/[3-steroids are prevented from acting on the GABA-R receptor. It is to be understood that “blocking” is an entirely different effect than meant by “modulation” or “repression” or similar terms, which suggest that an action is still taking place, but to a lesser extent or at a slower rate.

The term “pharmaceutical composition” is used in its widest sense, encompassing all pharmaceutically applicable compositions containing at least one active substance and optional carriers, adjuvants, diluents, constituents etc. The term “pharmaceutical composition” also encompasses a composition comprising the active substance in the form of derivate or a prodrug, such as pharmaceutically acceptable salts, sulphates and esters. The manufacture of pharmaceutical compositions for different routes of administration falls within the capabilities of a person skilled in galenic chemistry.

The skilled person appreciates that a precursor is a compound that participates in a chemical reaction that produces another compound; and that a prodrug is a compound that, after intake, is metabolized (i.e. , participates in a chemical reaction) within the body into a pharmacologically active drug (i.e., another compound). The terms “precursor” and/or “prodrug” are used herein to describe a compound that participates in a chemical reaction to form 3a- ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1 or 3a-ethyl-3[3- hydroxy-5a-androstan-17-one as shown in Formula 2. Typically, the chemical reaction takes place after administration, or at administration of the compound of Formula 1 or of the compound of Formula 2. For example, a position of Formula 1 or 2 may be protected by a protection group. For example, the 3|3- hydroxygroup of Formula 1 or 2 may be protected, thus forming a precursor or a prodrug. The skilled person appreciates that the prodrug or precursor may for example be activated intracellularly (for example via metabolic enzymes) and/or extracellularly (for example in the milieu of gastrointestinal fluids, within the systemic circulation and/or other extracellular fluid compartments or near therapeutic target tissues/cells, relying on common enzymes such as esterases and phosphatases or target directed enzymes).

The term “cosmetic composition” is used in its widest sense, encompassing all cosmetically applicable compositions containing at least one active substance and optional carriers, adjuvants, diluents, constituents etc. The term “cosmetic composition” also encompasses a composition comprising the active substance in the form of derivate or precursor form, such as cosmetically acceptable salts, sulphates and esters. The manufacture of cosmetical compositions for different routes of administration falls within the capabilities of a person skilled art.

The terms “administration” and “mode of administration” as well as “route of administration” are also used in their widest sense. The pharmaceutical composition and cosmetic composition of the present invention may be administered in a number of ways depending largely on whether a local, topical or systemic mode of administration is most appropriate for the condition be treated. These different modes of administration are for example topical (e.g., on the skin), local (including ophthalmic and to various mucous membranes, for example vaginal and rectal delivery), oral, parenteral or pulmonary, including the upper and lower airways. The preparation of such compositions and formulations is generally known to those skilled formulation arts and may be applied to the formulation of the composition of the present invention.

Exemplary compositions for oral administration include suspensions which can contain, for example, microcrystalline cellulose for imparting bulk, alginic acid or sodium alginate as a suspending agent, methylcellulose as a viscosity enhancer, and sweeteners or flavoring agents such as those known in the art; and immediate release tablets which can contain, for example, microcrystalline cellulose, dicalcium phosphate, starch, magnesium stearate, calcium sulfate, sorbitol, glucose and/or lactose and/or other excipients, binders, extenders, disintegrants, diluents and lubricants such as those known in the art. Suitable binders include starch, gelatin, natural sugars such as glucose or beta-lactose, com sweeteners, natural and synthetic gums such as acacia, tragacanth or sodium alginate, carboxymethylcellulose, polyethylene glycol, waxes and the like. Disintegrators include without limitation starch, methylcellulose, agar, bentonite, xanthan gum and the like. The compound can also be delivered through the oral cavity by sublingual and/or buccal administration. Molded tablets, compressed tablets or freeze-dried tablets are exemplary forms which may be used. Exemplary compositions include those formulating the present compound(s) with fast dissolving diluents such as mannitol, lactose, sucrose and/or cyclodextrins. Also included in such formulations may be high molecular weight excipients such as celluloses (avicel) or polyethylene glycols (PEG). Such formulations can also include an excipient to aid mucosal adhesion such as hydroxy propyl cellulose (HPC), hydroxy propyl methyl cellulose (HPMC), sodium carboxy methyl cellulose (SCMC), maleic anhydride copolymer (e.g., Gantrez), and agents to control release such as polyacrylic copolymer (e.g. Carbopol 934). Lubricants, glidants, flavors, coloring agents and stabilizers may also be added for ease of fabrication and use. Lubricants used in these dosage forms include sodium oleate, sodium stearate, magnesium stearate, sodium benzoate, sodium acetate, sodium chloride and the like. For oral administration in liquid form, the oral drug components can be combined with any oral, non-toxic, pharmaceutically or cosmetically acceptable inert carrier (where appropriate) such as ethanol, glycerol, water, and the like.

Compositions of the present invention suitable for oral administration may be presented as discrete units such as capsules, cachets, pills or tablets each containing a predetermined amount of the active ingredient; as a powder or granules; as a solution or a suspension in an aqueous liquid or a nonaqueous liquid, for example as elixirs, tinctures, suspensions or syrups; or as an oil-in-water liquid emulsion or a water-in-oil liquid emulsion. The active ingredient may also be presented as a bolus, electuary or paste.

A tablet may be made by compression or molding, optionally with one or more accessory ingredients. Compressed tablets may be prepared by compressing in a suitable machine the active ingredient in a free-flowing form such as a powder or granules, optionally mixed with a binder, lubricant, inert diluent, lubricating, surface active or dispersing agent. Molded tablets may be made by molding in a suitable machine a mixture of the powdered compound moistened with an inert liquid diluent. The tablets may optionally be coated or scored and may be formulated so as to provide slow or controlled release of the active ingredient therein. The present compounds can, for example, be administered in a form suitable for immediate release or extended release. Immediate release or extended release can be achieved by the use of suitable pharmaceutical or cosmetic compositions comprising the present compounds, or, particularly in the case of extended release, by the use of devices such as subcutaneous implants or osmotic pumps. The present compounds can also be administered liposomally.

Typical unit dosage compositions are those containing an effective dose, as hereinbefore recited, or an appropriate fraction thereof, of the active ingredient.

It should be understood that in addition to the ingredients particularly mentioned above, the compositions of this invention may include other agents conventional in the art having regard to the type of formulation in question, for example those suitable for oral administration may include flavoring agents.

With the term “antagonist” is meant a substance that hinders another substance, an agonist, to induce its effect. In this application the terms antagonist and blocker are used interchangably.

The term “obesity” refers to a condition in a patient having a BMI >30. The BMI may be >35. The BMI may be >38. The BMI may be >40.

The term “overweight” refers to a condition in a subject having a BMI >25 but <30.

The term “Prader-Willi’s syndrome” refers to a condition in a patient having at least one error in chromosome 15.lt also refers to a condition in a patient that is of similar symptomatology. This similar symptomatology forms the diagnosis of Prader-Willi syndrome in a subject that does not have a visible at least one error in chromosome 15. The skilled person is aware of the genetic mutations underlying Prader-Willi’s syndrome and the symptomatology that forms the diagnosis of said syndrome in cases where the patient does not have a visible error on chromosome 15. The term “Poly cystic ovarian syndrome” refers to a condition in a patient fulfilling the so called “Rotterdam criteria” as established by the American Society for Reproductive Medicine (ASRM) and the European Society for Human Reproduction and Embryology (ESHRE) at a meeting in Rotterdam in 2003.

The term “hyperphagia disorder” refers to an abnormally increased appetite for consumption of food. Hyperphagia disorder may be associated with injury to the hypothalamus.

The term “binge eating disorder” refers to a subject who suffers from recurrent episodes of eating large quantities of food and a feeling of loss of control. The full criteria for diagnoses of the disease is given in Diagnostic and Statistical Manual of Mental Disorders (DSM; latest edition: DSM-5, publ. 2013) as established by the American Psychiatric Association.

With the phrase "GAMSA" is meant compounds that only antagonize the action of positive GABAA receptor modulating steroids. When such compounds only antagonize or block the action of positive GABAA receptor modulating steroids, they have a "GAMSA effect". The abbreviation "GAMSA" stands for GABAA receptor modulating steroid antagonist.

As used herein, the term "patient" refers to an individual who is exhibits or is at risk of exhibiting symptom(s) of a disorder relating to obesity and/or hyperphagia disorder.

As used herein, the terms “a3 subtype GABAA receptor” and “GABAA receptor a3 subtype” are used interchangeably.

As used herein, when the term “about” or “approximately” is used in relation to a numerical value, it is to be interpreted as a range of ± 10 %, such as ± 9 %, such as ± 8 %, such as ± 7 %, such as ± 6 %, such as ± 5 %, such as ± 4 %, such as ± 3 %, such as ± 2 %, such as ± 1 %. For example, when the value is stated to be about 10, this means that the value is in fact in the range of from 9 to 11 , such as in the range of from 9.9 to 10.9, such as in the range of from 9.8 to 10.8, such as in the range of from 9.7 to 10.7, such as in the range of from 9.6 to 10.6, such as in the range of from 9.5 to 10.5, such as in the range of from 9.4 to 10.4, such as in the range of from 9.3 to 10.3, such as in the range of from 9.2 to 10.2, such as in the range of from 9.1 to 10.1.

The skilled person knows that numerical values relating to measurements are subject to measurement errors which place limits on their accuracy. For this reason, the general convention in the scientific and technical literature is applied: the last decimal place of a numerical value indicates its degree of accuracy. Where no other error margins are given, the maximum margin is ascertained by applying the rounding-off convention to the last decimal place e.g. for a measurement of 3.5 cm, the error margin is 3.45-3.54. When interpreting ranges of values in patent specifications, the skilled person proceeds on the same basis.

While the invention has been described with reference to various exemplary aspects and embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the invention. Therefore, it is intended that the invention is not limited to any particular embodiment contemplated, but that the invention will include all embodiments falling within the scope of the appended claims. The invention will be further illustrated by the following non-limiting Examples.

References

Tian et al., 2019, J. Diabetes Res., doi: 5783545

Prud'homme et al., 2015, Autoimmun Rev., 11 , 1048-56

Wang et al. 2000, Acta Physiol Scand.^QQ, 333-341 Wang et al. 2002, J Neurosci., 22(9):3366-75

Frye et al. 2000, Pharmacol Biochem Behav, 67, 587-596

Rose et al. 2018, Obesity. 26(11 ):1727-1732

Bhandage et al. 2021, Cell Mol Life Sci, 78, 5667-5679

Lindquist et al. 2006, J Neurochem, 97(5):1349-1356 Olsen et al. 2009, Neuropharmacology, 56(1 ):141 -148 Uusi-Oukari M et al, 2010, Pharmacol Rev, 62(1):97-135 Tian J et al. 2011 , Autoimmunity, 44:465-470

Bhat R et al. 2010, Proc Natl Acad Sci USA, 107(6):2580-2585

Li J et al, 2017, Cell 168(1 -2):86-1 OO.el 15

Brief description of the drawings

Figure 1 shows the response of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one (also denoted GR3047, filled line) and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one (also denoted GR3054, dotted line), respectively, in the presence of 100 pM GABA, at the a3p3y2L subtype of the GABAA-receptor. The response is in the concentration interval 0.01 - 10 pM.

Figure 2 shows graphs of the response of 3a-ethyl-3[3-hydroxy-5a-pregnan- 20-one (also denoted GR3047, filled line) and 3a-ethyl-3[3-hydroxy-5a- androstan-17-one (also denoted GR3054, dotted line), respectively, on THDOC enhanced GABA signaling on the a3p3y2L subtype of the GABAA- receptor. The GABA response is subtracted from the THDOC effect, to show the real THDOC enhancement.

Figure 3 shows the weight increase in grams in rats treated with 3a-ethynyl, 3[3-hydroxy-5a-androstan-17-one for five days. Grey stables are the increase from arrival of the rat and white stables from the start of the treatment. It is shown that treated rats exhibited a lower increase in weight compared to the control group. Figure 3A shows the increase from the start of treatment and Figure 3B shows the increase from arrival. Figure 4 shows the difference in weight after 10 days of treatment of rats with two different doses of 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one, vehicle or estradiol+progesterone. The weight difference is normalized from the vehicle mean.

Example 1: Synthesis of steroids of the invention

General considerations

It has been identified that a reaction of the ethyl Grignard reagent with 3, 20/17 diketone steroids is in most cases selective for the position 3 and thus, no need for protection/deprotection for ketone functionality on carbon 20/17 is required. Both 3a and 3(3 isomers are formed, which can be separated by chromatographic methods and recrystallized.

Starting materials for synthesizing 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one are the corresponding steroids with 3-hydroxy substituent and keto group in positions 20. They can be converted to the respective diones by oxidation with IBX reagent. The reaction proceeds smoothly and with complete conversion. Other suitable steroids can be employed as starting material when required such as 5a-pregnan-3, 20-dione. The reactions were carried out in suitable solvents such as methanol, ethanol, water, tetrahydrofuran (THF), diethyl ether, dichloromethane (DCM) or other solvents apparent to a person of skill in the art. When the reactants are chosen in a specific order it is possible to avoid, the use of toxic reactants, such as heavy metals, which are toxic even in traces or are difficult to be completely removed in the workup procedure.

Reactions involving air or moisture sensitive reagents, or products were carried out under inert atmosphere, such as nitrogen or argon gas, and in the presence of dry solvents. Diethyl ether and tetrahydrofuran were dried over Na in the presence of benzophenone. Syringes purged with inert gas were used for the transfer of reagents and dry solvents. Optimized time and temperature of the reactions were determined by monitoring the formation of products and the loss of starting material using a suitable chromatographic technique such as TLC or GC/MS.

Purifications were carried out by using chromatographic techniques such as flash silica chromatography or preparative high performance liquid chromatography (HPLC) by using a HPLC apparatus. Those skilled in the art can recognize that alternative purification methods can be employed, and laboratory chromatographic techniques can be adapted to industrial scale by using chromatographic columns for scaled preparations. Identification of the products are carried out by using suitable analytical techniques such as 1 H- NMR, ¹³ C-NMR, mass spectrometry, IR spectroscopy, X-ray spectroscopy and any other assay that one skilled in the art can recognize as suitable for structural identification and purity determination of 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one. A person skilled in the art will recognize that similar reagents, solvents, conditions, and parameters can be used in the reactions, depending on the substrate. NMR data are recorded using a Bruker 400 MHz spectrometer.

Synthesis of 3a-ethyl-3B-hydroxy-5a-preqnan-20-one

First step: synthesis of 3a-ethynyl-3/3-hydroxy-5a-pregnan-20-one 5a-pregnane-3, 20-dione (1 .580 g, 5.0 mmol) was dissolved in 50 mL dry THF at room temperature (RT) under nitrogen. Ethynyl magnesium bromide (1.1 equiv) was added dropwise at RT under stirring and the solution was left stirring overnight at rt under nitrogen flow.

The yellowish solution was then quenched with saturated NH4CI( _aq ) and the aqueous phase extracted with dichloromethane (3 x 30 mL). The collected organic phases were evaporated under reduced pressure, the resulting yellow oil dissolved in dichloromethane, washed with brine and dried over MgSCU. The solution was reduced under vacuum, and the residue purified by silica flash column chromatography (1 :4 diethylether : dichloromethane). The synthesis was repeated several times and typical yields were 72%. Eventual traces of byproducts may be eliminated by further recrystallization from diethyl ether.

¹ H N MR (400 MHz, CDCI ₃ ): 6 2.51 (t, 1 H); 2.47 (s, 3H); 2.14 (m, 1 H); 2.11 (s, 3H); 0.81 (s, 1 H); 0.60 (s, 3H).

Second step: synthesis of 3a-ethyl-3/3-hydroxy-5a-pregnan-20-one 3a-ethynyl-3[3-hydroxy-5a-pregnan-20-one (116 mg, 0.34 mmol, product of first step) was dissolved in 30 mL ethanol and 5 mL dichloromethane. Some drops of glacial acetic acid and a small amount Pd/C 10 % were added to the solution. The skilled person appreciates the meaning of small amount in the context of this synthesis step.

Hydrogen (T = 25 °C and P = 1 Atm) was bubbled into the solution overnight while stirring. The resulting mixture was filtered over filter paper and then over celite, yielding a clear solution, which was evaporated under reduced pressure. The resulting crude was dissolved in 10 mL dichloromethane and washed with an aqueous solution of NaHCOs. The organic phases were then collected and dried over MgSCU, and filtered. The solvent removed under reduced pressure, yielding 105 mg (0.30 mmol, 88 % yield) white crystals.

¹ H NMR (400 MHz, CDCI3): 6 2.51 (t, 1 H); 2.15 (m, 1 H); 2.11 (s, 3H); 2.00 (m, 1 H); 0.88 (t, 3H); 0.83 (s, 3H); 0.60 (s, 3H).

Synthesis of 3a-ethyl-36-hydroxy-5a-androstan-17-one

First step: synthesis of 3a-ethynyl-3/3-hydroxy-5a-androstan-17-one 3,17-5a-androstandione (5.0 mmol) was dissolved in 50 mL dry THF at rt under nitrogen. Ethynyl magnesium bromide (1.1 equiv) was added dropwise at RT under stirring and the solution was left stirring overnight at rt under nitrogen flow. The yellowish solution was then quenched with saturated NH4CI( _aq ) and the aqueous phase extracted with dichloromethane (3 x 30 mL). The collected organic phases were evaporated under reduced pressure, the resulting yellowish oil dissolved in dichloromethane, washed with brine and dried over MgSCU. The solution was reduced under vacuum, and the residue purified by silica flash column chromatography (1 :4 diethylether : dichloromethane). The synthesis was repeated several times and typical yields were 65 %.

¹ H NMR (400 MHz, CDCI ₃ ): 6 2.40 (s, 1 H); 2.37 (m, 1 H); 2.0 (m, 1 H); 0.79 (s, 3H); 0.77 (s, 3H).

Second step: synthesis of 3a-ethyl-3/3-hydroxy-5a-androstan-17-one 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one (98 mg, 0.31 mmol) was dissolved in 30 mL ethanol and 5 mL dichloromethane. Some drops glacial acetic acid and a small amount Pd/C 10 % were added to the solution. The skilled person appreciates the meaning of small amount in the context of this synthesis step.

Hydrogen (T = 25 °C and P = 1 Atm) was bubbled into the solution overnight while stirring. The resulting mixture was filtered over celite, yielding a clear solution, which was evaporated under reduced pressure. The resulting crude was dissolved in 10 mL dichloromethane and washed with an aqueous solution of NaHCOs. The organic phases were then collected and dried over MgSCU, filtered and the solvent removed under reduced pressure, yielding 90 mg (0.28 mmol, 91 % yield) white crystals.

¹ H NMR (400 MHz, CDCI3): 6 2.37 (m, 1 H); 2.0 (m, 1 H); 0.81 (t, 3H); 0.79 (2x s, 6H).

Example 2: Effect of 3a-ethyl-3p-hydroxy-5a-pregnan-20-one and 3a- ethyl-3p-hydroxy-5a-androstan-17-one on the GABA _A -receptor subtype a1, a2, a3, a4 and a5 Aim: To investigate the effect of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one on the GABAA-receptor function in absence and in presence of GABA and the GAMS tetrahydrodeoxycorticosterone (THDOC) by the Dynaflow™ system on HEK- 293 cells expressing the a1 -(32-y2L, a2-p3-y2S, a3-p3-y2L, a4-[33-5 and a5- (33-y2L GABAA-receptor subtypes, respectively. In these tests the protocol was optimized to be like the physiological conditions in the synaptic cleft.

Materials and methods

Apparatus used

• Axonpatch 200B, Axon Instruments (Foster City, CA, USA)

• BD Plastikpak 2 ml syringes, Becton Dickinsson S.A. (Madrid, Spain)

• Borosilicate glass pipettes, OD 1 ,5mm, ID 0.86 mm, 10 mm of length (Bergmanlabora AB, Danderyd, Sweden)

• Digidata 1322A, Axon Instruments (Foster City, CA, USA)

• Dynaflow Pro II Platform Zeiss Axiovert 25, Fluicell AB (Mdndal, Sweden)

• Dynaflow Resolve chip, Fluicell AB, (Mdndal, Sweden)

• GraphPad Prism, GraphPad Software Inc. (San Diego, CA, USA)

• Incubator Mini Galaxy A, Model number 500, LabRum Klimat AB (Stockholm, Sweden)

• Patch CLAMP hardware; Axon Instruments (Foster City, CA, USA)

• pCLAMP software; Axon Instruments (Foster City, CA, USA)

• SPSS statistical package version PASW (SPSS Inc. Chicago, IL, USA)

Solutions and chemicals

EC-solution (in mM):

137 NaCI, AnalaR, Normapur, Leuven, Belgien, Lot 10B230005 5.0 KCI, Scharlau, (Barcelona, Spain), Lot 71782

1.0 CaCI2, Merck, (Darmstadt, Germany), Lot A609382526 1 .2 MgCI2 x 6H2O, Scharlau, (Barcelona, Spain), Lot 61629 10 HEPES, Saveen Werner AB (Limhamn, Sweden), Lot 61915 10 glucose, VWR International, (Poole, England), Lot K33805414524 pH was adjusted with 1 M NaOH (Eka Chemicals AB, Bohus, Sweden) Lot 131004 to 7.4.

IC-solution with ATP (in mM):

3.0 NaCI, AnalaR, Normapur, Leuven, Belgien, Lot 10B230005 1.2 MgCI2 x 6H2O, Scharlau, (Barcelona, Spain), Lot A609382526 10 HEPES, Saveen Werner AB (Limhamn, Sweden), Lot 61915 1.0 EGTA, Sigma Chemical Co. (St. Louis, MO, USA)

140 Cs-gluconate, provided by Dr. Ragagnin, Umecrine AB, Umea, Sweden 2 Mg-ATP, Sigma Chemical Co. (St. Louis, MO, USA), Lot 010M51521V pH was adjusted with 1 M CsOH Sigma Chemical Co. (St. Louis, MO, USA) to 7.2.

GABA (Gamma aminobutyric acid), Sigma Chemical Co. (St. Louis, MO, USA), Lot 081 K2064

THDOC, Sigma Chemical Co. (St. Louis, MO, USA), Lot 030M4041 Trypsin-EDTA 0.25 % 1x, Invitrogen (Carlsbad, California, USA) DMEM + Glutamax, Invitrogen (Carlsbad, California, USA)

KM (DMEM+GlutaMax, FBS (Foetal Bovine Serum), Penicillin-Streptomycin). All chemicals from Invitrogen (Carlsbad, California, USA).

Preparation of cell lines: HEK-293 cells permanently transfected with the human a1-(32-y2L, a2-(33-y2S, O3-|3|33-Y2L, a4-[33-5 or a5-(33-y2L GABAA- receptor subtypes were used. The cell lines permanently expressing a functional human GABAA-receptor was made in following steps. The human GABA _A -receptor subunits e.g. a1 (308-1727 NM_000806), (32 (214-1679 NM_000813), y2L (290-1785 NM_198904), a2, [33, y2S, a3, a4, 5 and a5 including introduced Kozac sequences just before the start codons were subcloned into mammalian expression vectors containing Geneticin, Hygromycin B, and Zeocin resistance, respectively. A HEK-293 cell line stably expressing the three GABAA-receptor subunits was produced by transfection of the subunits, one at a time. The transfection was followed by selection with the appropriate antibiotics, cell separation with the use of subunit specific antibodies and production of single cell colonies. Produced cell lines were analysed with immunocytochemistry for the three GABAA-receptor subunits, followed by selection of a suitable cell line showing, for the GABAA-receptor normal and good reactivity in a patch-clamp analysis (see below) towards GABA and the GAMS THDOC.

Cell culture: HEK-293 cells, permanently transfected with human a1-(32-y2L, a2-(33-y2S, a3-p3-y2L, a4-[33-5 and a5-p3-y2L GABAA-receptor subtypes, were seeded at a density of 3 x 10 ⁴ /25 cm ² in cell binding culture flask. The transfected cells were used for patch-clamp experiments 3 days after seeding. When using the cells for patch-clamp experiments the cells were washed twice with oxygen-bubbled EC-solution (see below). About 5 mL EC was then added and the cells were kept in the incubator for about 15 minutes. After 15 minutes the cells came loose from the bottom of the flask and were separated by carefully sucking couple of times with a Pasteur pipette.

Dynaflow™ system: Dynaflow™ system with resolve chips was used for all patch-clamp experiments. The resolve chips is made of non-sticky materials. The channel width is 150 pm and the height 50 pm. The well volume is 280 pL. Run time at the flow rate of 26 pL/min is 180 min. The pump settings were as follow: Omnifix 2 mL syringe with inner diameter of 9.65 mm was used. The syringe pump flow rate of chip was 26 pL/min.

Steroids and GABA: GABA was dissolved in EC-solution by ultrasound for about 40 minutes to the concentration of 10 mM in room temperature. All steroids were dissolved to the concentration of 6 mM in dimethyl sulfoxide (DMSO). The DMSO concentration was 0.1 % in all end-solutions, including the wash solution (EC) and the solution with GABA alone. End-solutions are the solutions added into the wells of the chip. Electrophysiology: Patch electrodes were pulled from 1.5 mm O.D., 0.86 mm I.D. borosilicate capillary glass without filament. Typical electrodes had a resistance of 2-5 MQ when filled with intracellular solutions. The intracellular solution (IC) comprised of (in mM): 140 Cs-gluconate, 3.0 NaCI, 1.2 MgC , 1 .0 EGTA, 10 HEPES. pH was adjusted to 7.2 with CsOH. The extracellular (EC) solution used during recordings contained (in mM): 137 NaCI, 5.0 KCI, 1 .0 CaC , 1 .2 MgC , 10 HEPES, 10 glucose. pH was adjusted with NaOH to 7.4. After compensating for the liquid junction potential, a steady holding potential of -17 mV was used in all experiments. In physiological conditions the H EK-293 has a resting potential at -40 mV and a low concentration of chloride ions inside the cell. By using the holding potential of -17 mV and the intracellular solution with low chloride ion concentration the chloride ions flux into the cell when the receptors are activated. All experiments were performed at room temperature (21 to 23°C). The following standard protocol was used for all experiments.

Protocol

GABA applications: By using the Dynaflow equipment it is possible to study transfected H EK-293 during almost physiological conditions. The Dynaflow system allows application of solutions for as short as 40 ms up to minutes in time. Physiologically, in the synaptic cleft, GABA is released in mM range for about 2 ms. This is valid for a1 , a2 and a3 receptors. In extra synaptic sites the GABA levels are lower but stay on for longer time. This is valid for the a4 and a5 receptors. In these experiments we have applied GABA ± steroid for 40 ms. It was found that in almost all cells, the first GABA application gave a smaller response than the second GABA application. There was no difference in response between the second and the third or following GABA application. Therefore, the first GABA application is always repeated twice, and the second response is used in the analysis.

Washout: GABA is quite soluble in water and easy to washout from the receptor. The washout time was set to 1 minute after application with GABA solely. Steroids on the other hand are difficult to dissolve in water and also difficult to washout from the receptor. In the experiments, THDOC was used as the GABA agonist. With 2 minutes washout time, 200 nM THDOC had been completely washed out as shown by neither an accumulative nor a desensitization effect.

Incubation: To see the effect of the steroids and to achieve stable results it was found out that the steroids (THDOC and 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one) have to be incubated on the receptor before application of GABA. Different incubation times were studied to achieve the optimal time for attaining stable results and minimizing the washout time. Incubation time of 20 seconds showed to be the optimal time for washout time of 2 minutes.

The optimized protocol: The optimized protocol is like follow: 20 seconds incubation of steroids, 40 ms. GABA ± steroids (THDOC and 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one) application, 2-m inute washout. The first GABA application is repeated twice with a washout time of 1 min. between the first and the second application.

Results and conclusion of Example 2

Table 1 B shows the results from the studies on current response mediated by chloride ion flux through the GABAA-receptors expressing the human a1 |32y2L, a2(33y2S, a3p3y2L, a4[335 and a5p3y2L GABAA-receptor subtypes. Patch clamp technique combined with the Dynaflow™ application system, which provides rapid applications of and removal of substances, was used in this study. The effect shown was provided by 1 pM 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one or 1 pM 3a-ethyl-3[3-hydroxy-5a-androstan-17-one on the GABA response at the five different GABAA-receptor subunits. As shown in Table 1 B, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one (3a-ethyl-3[3- hydroxy-5a-pregnan-20-one) had, an agonistic enhancing effect on GABA in the a1 (32y2L GABAA-receptor subtype and an antagonizing effect on GABA in a3p3y2L. However, no significant antagonistic or agonistic effect against GABA’s effect in a2(33y2S, a4[33b and a5p3y2L GABAA-receptor subtypes was observed.

The results of 3a-ethyl-3[3-hydroxy-5a-androstan-17-one (3a-ethyl-3[3- hydroxy-5a-androstan-17-one) were surprisingly different. 3a-ethyl-3[3- hydroxy-5a-androstan-17-one showed a significant antagonistic effect on all receptor subtypes tested. The antagonism was larger than for 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one for all tested receptor subtypes and the largest effect was seen in a3(33y2L and a5p3y2L (Table 1 B).

Thus, it was concluded that 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one acts different for the tested subtypes and provides agonistic enhancing effect on GABA in the a1 subtypes of the GABAA-receptor, while providing an antagonizing effect on GABA in the a3 subtypes of the GABAA-receptor. It was also concluded that 3a-ethyl-3[3-hydroxy-5a-androstan-17-one provides an antagonistic effect for the a1 , a2, a3, a4 and a5 receptor subtypes of the GABAA-receptor.

Table 1B. The effect by 1 M 3a-ethyl-3/3-hydroxy-5a-pregnan-20-one and 3a- ethyl-3/3-hydroxy-5a-androstan-17-one, respectively, on GABA response.

3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a- androstan-17-one had no effect on the GABAA-receptors alone without GABA present.

The effect of 0.01 - 10 pM steroid + 100 pM GABA at the a3B3y2L subtype of the GABAA-receptor receptor

3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a- androstan-17-one were tested in the concentration interval 0.01-10 pM on 100 pM GABA mediated current response at the GABAA-receptor subtype a3(33y2L (Fig. 1 ).

Results: From the best fit curve the IC50 was calculated. IC50 was quite similar for 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy- 5a-androstan-17-one, 1.7 pM and 0.9 pM respectively. 3a-ethyl-3[3-hydroxy- 5a-androstan-17-one was however more efficient with an l _ma x of - 77 % and a significant reducing effect, more than 10 %, already at 0.3 pM (Table 2). 3a- ethyl-3[3-hydroxy-5a-pregnan-20-one had a significant reducing effect, more than 30 %, at 3 pM and the lmax of - 47 % (Table 2). 0.01 - 10 pM 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3- hydroxy-5a-androstan-17-one were also tested in absence of GABA to investigate whether the steroids activate the GABAA-receptor by themselves.

Neither 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one nor 3a-ethyl-3[3-hydroxy-5a- androstan-17-one did activate the receptor in the absence of GABA (data not shown).

Table 2. The effect of 0.01 - 10 M 3a-ethyl-3fi-hydroxy-5ct-pregnan-20-one and 3a-ethyl-3/3-hydroxy-5a-androstan-17-one on 100 pM GABA response at GABAA receptor subtype o3/33y2L

The effect of 0.03 - 3 pM steroid on TH DOC enhancement of GABA in human GABAA-receptor subtype a3B3y2L

As known to persons of skill in the art, THDOC enhances the effect of GABA in all types of GABAA-receptors. To fully investigate the effect of 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one in the a3(33y2L receptor subtype, 0.03 - 3 pM 3a-ethyl-3[3-hydroxy-5a-pregnan- 20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one were tested on an THDOC enhanced GABA response at the a3(33y2L receptor subtype. THDOC was used in 100 nM and GABA in 100 pM. The THDOC enhancement is the effect by THDOC when the GABA response is subtracted. As such, it represents the real THDOC enhancement of the GABA effect.

Results and discussion: At the best fit of the concentration-dependent curve, the maximal inhibition by 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a- ethyl-3[3-hydroxy-5a-androstan-17-one is -100 % (Fig. 2). More than -100 % inhibition shows that the steroids GR 3047 and 3a-ethyl-3[3-hydroxy-5a- androstan-17-one blocks the THDOC enhancement entirely and furthermore reduce the GABA response. This is shown in table 3 for both compounds of the invention.

0.03 - 3 pM 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one reduce the THDOC enhancement in a concentration dependent way where the best fit curve shows an IC50 of 0.4 pM (Fig. 2). 3 pM 3a-ethyl-3[3-hydroxy-5a-pregnan-20- one completely block the THDOC enhancement (Fig. 2 and Table 3).

Table 3. The effect of 0.03 - 3 M 3a-ethyl-3fi-hydroxy-5a-pregnan-20-one and 3a-ethyl-3/3-hydroxy-5a-androstan-17-one on reduction of THDOC- enhanced GABA effect in GABAA receptor subtype o3/33y2L

Discussion on 3a-ethyl-36-hydroxy-5a-preqnan-20-one: On the a3p3y2L receptor subtype, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one is an antagonist against THDOC enhancement of GABA in concentrations above 300 nM (Table 3). 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one thus show specificity depending on the receptor subtype and is thus selective in its action on the GABA receptor system. Less side effects are envisioned since the molecule is not active on the a1 [322L. As described above, the a1 subtype is a more general subtype.

3a-ethyl-3[3-hydroxy-5a-pregnan-20-one had a slight agonistic effect on THDOC’s autonomic opening of the a3(33y2L GABAA-receptor. This agonistic effect is so small that it has no relevance and in the range of the vehicle.

Discussion on 3a-ethyl-3B-hydroxy-5a-androstan-17-one: 3a-ethyl-3[3- hydroxy-5a-androstan-17-one had an antagonistic effect on the THDOC enhancement of GABA at a3p3y2L GABAA-receptor already at 0.1 pM. 3a- ethyl-3[3-hydroxy-5a-androstan-17-one has also an antagonistic effect against GABAs effect on a3p3y2L GABAA-receptor at a concentration of 0.3pM and higher. 3a-ethyl-3[3-hydroxy-5a-androstan-17-one exhibits a lower antagonistic effect on the a1 p2y2L receptor subtype compared to the a3p3y2L and a5p3y2L GABAA-receptor subtypes.

In conclusion, example 2 shows that the two compounds 3a-ethyl-3[3- hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one have different pharmacological properties and can therefore be used in different situations as medicaments and pharmaceuticals.

Example 3: Effect of 3a-ethynyl-3p-hydroxy-5a-androstan-17-one on weight increase in animal model of growing male rats.

In this example, the effect of 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 3 on weight increase in an animal model of growing male rats is investigated.

Treatment and testing schedule

Animals: Male Wistar rats were kept in group cages, with three animals per cage, from delivery and throughout the period of experiments. The individual animals were marked so that they could be identified throughout the experiment duration. The animals weight an average of 152 g upon arrival. A reversed light dark (12: 12h) cycle was used with the dark period onset at 0600 hrs. Altogether fifty-six (56) rats were used in this study (experiment 1 +2). The animals were delivered from the breeder Taconic (Denmark). The study protocol was approved by the Regional Ethics Committee of Umea University, Sweden.

Feeding: Standard chow and water were available ad libitum. A reversed 12-h dark-light cycle with lights off at 10.00 am and lights on at 22.00 pm was used. For identification, the rats were marked with a permanent marker on the tail. To avoid the endogenous allopregnanolone fluctuations that are present in the oestrous cycle of female rats, male rats were chosen (Frye et al. 2000). The animals were allowed to acclimatize for at least 3 weeks before start of the experimental sessions. During this period, the rats were repeatedly handled and allowed habituation to the new environment and to all new procedures, to minimize stress during the experiments.

Experimental design

After 14 days of triad housing, handling and injection training of the animals, the animals were treated for 5 days with IV injections in experiment 1 and 10 days with a daily subcutaneous injection of the assigned treatment in experiment 2 (Tables 4 and 5). The injections were given at 08.00 every morning. The animals were weighed the day before onset of the treatment and at the last day of injection i.e. on the 5th or 10th day of treatment. Weight was taken at the time of the last injection. A one-way ANOVA and non- parametric Kruscal-Wallice test showed differences for the treatment dosages compared to vehicle treatment. The results are shown in Figure 3 (experiment 1 ) and Figure 4 (experiment 2), respectively. Post hoc p-values are indicated in the Figures.

Treatment groups

Table 4: Treatment groups in experiment 1.

Table 5: Treatment groups in experiment 2.

Results example 3

Experiment 1 : As can be seen in Figure 3, there was no significant difference between the two vehicle treatments 10% or 20% 2-Hydroxypropyl-p- cyclodextrin. The increase in weight was significantly lower in the 3a-ethynyl- 3[3-hydroxy-5a-androstan-17-one-treated group than in the vehicle treated groups F(2, 18)= 6,293; p<0.008 when compared to weight at arrival to department or F(2, 18)= 6, 103; p<0.009, or compared to weight at the start of treatment (Table 6). Ad hoc analysis of the weight increase from the arrival to the department shows a significant difference between 3a-ethynyl-3[3- hydroxy-5a-androstan-17-one treatment and treatment with vehicle 10% (p<0.002) and a trend for significance against treatment with 20% [3- cyclodextrin solution (p=0.065). The ad hoc test of the weight increase between start and end of treatment showed significant difference between the 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one treatment and vehicle treatment (p<0.003 for 10%) and a trend (p=0.063 for 20%). There was no significant difference between the weight changes in the vehicle treated groups. The cyclodextrin content in the 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one solution was 1 ml/kg while the cyclodextrin concentration in the vehicles was six times higher.

Table 6: Weight changes (mean, SEM gram) during vehicle and 3a-ethynyl- 3/3-hydroxy-5a-androstan-17 -one treatment

Figure 3 shows the mean ± SEM weight changes in grams (g) the weight difference between the weight at the start of the treatment minus the weight at five days later at the end of treatment (top, white stables) between the weight at arrival to the department minus the weight at the last day of treatment (bottom, grey stables). Antagonist 2mg/kg = 3a-ethynyl-3[3-hydroxy-5a- androstan-17-one 2 mg/kg.

Experiment 2: The results show of 3a-ethynyl-3[3-hydroxy-5a-androstan-17- one reduced the weight increase compared to controls treated with vehicle (placebo) or 5 mg/kg progesterone (P) + 10 pg/kg 17|3-estradiol (E) sub cutaneous (s.c.). The reduction in weight was surprising large as the weight already after 10 days of treatment differed over 20% compared to vehicle, see Figure 3. The results indicate that 3a-ethynyl-3[3-hydroxy-5a-androstan-17- one is very suitable to use as a treatment in e.g. adolescents with Prader- Willis syndrome.

Results and conclusion Example 3: Figure 4 shows the weight difference (Mean±SE) normalized from the vehicle and estradiol (E) +progesterone (P) control mean (set as 0±SE g weight) in the groups treated with two dosages of 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one. The results show that 3a- ethynyl-3[3-hydroxy-5a-androstan-17-one reduced the weight increase compared to controls treated with vehicle (placebo). Both dose groups, 1 mg/kg (n=9) and 5 mg/kg (n=9) showed a significant reduction in weight compared to vehicle (-33±4.4 g; and -29,6±5.2g resp. p<0.001 in both groups, Figure 3). The 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one treated groups showed also a significantly reduced weight versus the E+P control rats (- 23.9±4.4g vs. -20.4±5.2g p<0.001 and p=0.003, figure 4). The reduction in weight was surprisingly large as the weight already after 10 days of treatment differed over 20%. The results indicate that 3a-ethynyl-3[3-hydroxy-5a- androstan-17-one is very suitable to use in prevention, alleviation or treatment of a disease associated with an a3 subtype of the GABAA receptor, such as obesity, hyperphagia disorder, Prader-Willi’s syndrome, polycystic ovarian syndrome, and/or diabetes. The present inventors consider that the compound of the invention to be particularly suitable for use in a patient with Prader-Willis syndrome, such as in adolescents with Prader-Willis syndrome.

Example 4: Effect of 3a-ethyl-3p-hydroxy-5a-pregnan-20-one and 3a- ethyl-3p-hydroxy-5a-androstan-17-one on weight increase in animal model of growing male rats.

In the same way as in example 3, the molecules of the present invention are investigated. 3a-ethynyl-3p-hydroxy-5a-androstan-17-one is replaced by 3a- ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan- 17-one in an experiment with the same outline as example 3.

Table 7. Effect of 1pM 3a-ethynyl-3/3-hydroxy-5a-androstan-17-one on receptor subype 1/32y2 and o3/33y2. Experiment performed essentially as described in Example 2.

The molecules of the invention, 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one are structurally similar to the molecule of example 3, 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one. They all share the androstane core and, importantly, the 3[3-hydroxy stereochemistry. Furthermore, 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one has an antagonistic effect on y-aminobutyric acid (GABA) and THDOC enhanced GABA signaling via the GABAA receptor subypes a3p3y2 similar to the compunds of the present invention (see Table 7).

Without being bound by any theory, it is envisioned that the 3a-ethyl-3[3- hydroxy stereochemistry is responsible for the effect on a a3 receptor subtype of the GABAA receptor.

Therefore, the skilled person will find it plausible that 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one behaves similarly to 3a-ethynyl-3[3-hydroxy-5a-androstan-17-one. 3a-ethyl-3[3-hydroxy- 5a-pregnan-20-one and 3a-ethyl-3[3-hydroxy-5a-androstan-17-one will thereby enable reduction in weight in a mammal.

The results will indicate that 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one and 3a- ethyl-3[3-hydroxy-5a-androstan-17-one are very suitable to use in prevention, alleviation or treatment of a disease associated with an a3 subtype of the

GABAA receptor, such as obesity, hyperphagia disorder, Prader-Willi’s syndrome, polycystic ovarian syndrome, and/or diabetes as well as in non- therapeutic treatment, prevention and/or alleviation of overweight. The present inventors consider that the compounds of the invention are to be particularly suitable for use in a patient with Prader-Willis syndrome, such as in adolescents with Prader-Willis syndrome.

Itemized list of embodiments

1 . A compound selected from the group consisting of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1 , and

3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2 (Formula 2) a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

2. The compound according to item 1 , wherein said compound is 3a- ethyl-3[3-hydroxy-5a-pregnan-20-one or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

3. The compound according to item 1 , wherein said compound is 3a- ethyl-3[3-hydroxy-5a-androstan-17-one, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

4. The compound according to any one of items 1 to 3, wherein said compound or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof comprises ³ H isotopes of hydrogen or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

5. The compound according to any one of items 1 to 3, wherein said compound or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof comprises ² H isotopes of hydrogen or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof or a cosmetically acceptable salt, hydrate, precursor or solvate thereof.

6. The compound according to any one of items 1 to 5, wherein said pharmaceutically or cosmetically acceptable salt is a sodium salt.

7. A compound according to any one of items 1 to 6, for use as a medicament.

8. A compound according to any one of items 1 to 6, for use in prevention, alleviation and/or treatment of a steroid-related CNS disorder or disease, of an autoimmune disease and/or of diabetes.

9. The compound for use according to item 8, wherein said use is in prevention, alleviation and/or treatment of a steroid-related CNS disorder and wherein said steroid-related CNS disorder or diseases selected from the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; and clumsiness.

10. The compound for use according to item 8 or 9, wherein said CNS disorder or disease, autoimmune disease, and/or diabetes is associated with an a3 subtype of the GABAA receptor, such as the a3p2y2 subtype of the GABAA receptor.

11 . The compound for use according to any one of items 8 to 10, wherein said steroid-related CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder, such as group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome and hyperphagia disorder associated with injury to the hypothalamus.

12. The compound for use according to any one of items 8 to 11 , wherein said steroid-related CNS disorder or disease is obesity.

13. The compound for use according to any one of items 8 to 11 , wherein said steroid-related CNS disorder is hyperphagia disorder. 14. The compound for use according to any one of items 8 to 11 , wherein said steroid-related CNS disorder or disease is Prader-Willi’s syndrome.

15. The compound for use according to any one of items 8 to 11 , wherein said steroid-related CNS disorder or disease is polycystic ovarian syndrome.

16. The compound for use according to any one of items 8, 10 and 11 , wherein said use is in prevention, alleviation and/or treatment of diabetes and wherein said diabetes is diabetes type II.

17. The compound for use according to any one of items 8 to 11 , wherein said steroid-related CNS disorder or disease is alcoholism or substance use disorder.

18. A compound according to any one of items 1 to 6, for use in prevention, alleviation and/or treatment of a condition caused by exposure to at least one endogenous or exogenous 3a-hydroxy-steroid.

19. A compound according to any one of items 1 to 6, for use in prevention, alleviation and/or treatment of a side effect caused by an antiinflammatory steroid, postmenopausal therapy, and/or an oral contraceptive.

20. The compound for use according to any one according to items 11 to 16, wherein use results in a decrease in bodyweight is seen after 1 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days.

21 . The compound for use according to any one of items 7 to 20, wherein said compound is administrated intravenously, nasally, per rectum, intravaginally, percutaneously, intramuscularly, or orally.

22. The compound according to item 21 , wherein said administration is oral or nasal administration.

23. The compound according to any one of items 7 to 22, wherein said compound is administrated in a dose of from about 0.1 to about 300 mg per kg body weight from about 0.2 to about 200 mg per kg body weight, such as a dose of from about 0.3 to about 150 mg, such as about 0.4 to about 150 mg per kg bodyweight, such as about 0.5 to about 120 mg per kg bodyweight, such as from about 1 to about 100 mg per kg body weight, such as from about 1 to about 50 mg per kg body weight, such from about 1 to about 5 mg per kg body weight, such as about 1 mg per kg body weight. 24. The compound according to item 23, wherein said dose is from about 0.2 to about 200 mg per kg body weight.

25. The compound according to any one of items 1 to 6 or the compound for use according to any one of items 7 to 24, wherein said compound provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA- receptor a3 subtype(s).

26. The compound according to any one of items 1 to 6 and 25 or the compound for use according to any one of items 7 to 25, wherein said compound provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) on the GABAA receptor a3 subtype(s).

27. The compound according to any one of items 1 , 3 to 6 or the compound for use according to any one of items 7 to 26 , wherein said compound further provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype(s).

28. The compound according to any one of items 1 , 3 to 6 and 25 to 27 or the compound for use according to any one of items 7 to 27, wherein said compound further provides an antagonistic effect on the effect of y- aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype(s) and wherein said compound is 3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2.

29. The compound according to any one of items 1 to 2, 4 to 6 and 25 to 26 or the compound for use according to any one of items 7 to 26 , wherein said compound further provides an agonistic effect on the effect of y- aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype(s), such as the a1 , a4 and/or a5 subtype(s); or wherein said compound further provides an agonistic effect on the effect of y-aminobutyric acid (GABA) on the GABAA receptor a1 , a2, a4 and/or a5 subtype(s), such as the a1 , a4 and/or a5 subtype(s), and optionally wherein said compound is 3a-ethyl-3[3-hydroxy-5a- pregnan-20-one as shown in Formula 1.

30. A pharmaceutical composition comprising a therapeutically effective amount of a compound as defined in items 1 to 6 or a compound for use according to any one of items 7 to 29, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, and at least one pharmaceutically acceptable excipient.

31 . A method of treating, alleviating and/or preventing a steroid-related CNS disorder or disease, an autoimmune disease, and/or diabetes, comprising administering a pharmaceutically effective amount of compound selected from the group consisting of 3a-ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1

3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2 a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, to a patient in need thereof. 32. The method of treating, alleviating and/or preventing according to item 31 , wherein said method is a method of treating, alleviating and/or preventing a steroid related CNS disorder and wherein said steroid-related CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; and clumsiness.

33. The method of treating, alleviating and/or preventing according to any one of items 31 to 32, wherein said CNS disorder or disease, autoimmune disease or disorder, and/or diabetes is associated with an a3 subtype of the GABAA receptor, such as the a3p2y2 subtype of the GABAA receptor.

34. The method of treating, alleviating and/or preventing according to any one of items 31 to 33, wherein said steroid-related CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader- Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity;

Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder, such as group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome and hyperphagia disorder associated with injury to the hypothalamus.

35. The method of treating, alleviating and/or preventing according to any one of items 31 to 34, wherein said steroid-related CNS disorder or disease is obesity.

36. The method of treating, alleviating and/or preventing according to any one of items 31 to 34, wherein said steroid-related CNS disorder is a hyperphagia disorder.

37. The method of treating, alleviating and/or preventing according to any one of items 31 to 34, wherein said steroid-related CNS disorder or disease is Prader-Willi’s syndrome.

38. The method of treating, alleviating and/or preventing according to any one of items 31 to 34, wherein said steroid-related CNS disorder or disease is polycystic ovarian syndrome.

39. The method of treating, alleviating and/or preventing according to any one of items 31 and 33, wherein method is a method of treating, alleviating and/or preventing diabetes and said diabetes is diabetes type II.

40. The method of treating, alleviating and/or preventing according to any one of items 31 to 34, said steroid-related CNS disorder or disease is alcoholism or substance use disorder.

41 . A method of treating, alleviating and/or preventing a condition caused by exposure to at least one 3a-hydroxy-steroid, comprising administering a pharmaceutically effective amount of compound according to any one of claims 1 to 6, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof.

42. A method of treating, alleviating and/or preventing a side effect caused by an anti-inflammatory steroid, postmenopausal therapy, and/or an oral contraceptive, comprising administering a pharmaceutically effective amount of compound according to any one of claims 1 to 6, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof, to a patient in need thereof.

43. The method of treating, alleviating and/or preventing according to any one according to items 31 to 42, wherein said method results in a decrease in bodyweight, optionally wherein said decrease is seen after 1 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days.

44. The method of treating, alleviating and/or preventing according to any one of items 31 to 43, wherein said compound is administrated intravenously, nasally, per rectum, intravaginally, percutaneously, intramuscularly, or orally.

45. The method of treating, alleviating and/or preventing according to item 44, wherein said administration is oral or nasal administration.

46. The method of treating, alleviating and/or preventing according to any one of items 31 to 45, wherein said compound is administrated in a dose of from about 0.1 to about 300 mg per kg body weight from about 0.2 to about 200 mg per kg body weight, such as a dose of from about 0.3 to about 150 mg, such as about 0.4 to about 150 mg per kg bodyweight, such as about 0.5 to about 120 mg per kg bodyweight, such as from about 1 to about 100 mg per kg body weight, such as from about 1 to about 50 mg per kg body weight, such from about 1 to about 5 mg per kg body weight, such as about 1 mg per kg body weight.

47. The method of treating, alleviating and/or preventing according to any one of items 31 to 46, wherein said dose from about 0.2 to about 200 mg per kg body weight.

48. The method of treating, alleviating and/or preventing according to any one of items 31 to 47, wherein said compound provides an antagonistic effect on the effect of y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA-receptor a3 subtype(s).

49. The method of treating, alleviating and/or preventing according to any one of items 31 to 48, wherein said compound provides an antagonistic effect on the effect of Y-aminobutyric acid (GABA) on the GABAA receptor a3 subtype(s). 50. The method of treating, alleviating and/or preventing according to any one of items 31 to 49, wherein said compound further provides an antagonistic effect on the effect of Y-arninobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a1 , a2, a4 and/or a5 subtype(s).

51 . The method of treating, alleviating and/or preventing according to any one of items 31 to 50, wherein said compound further provides an antagonistic effect on the effect of Y-arninobutyric acid (GABA) on the a1 , a2, a4 and/or a5 subtype(s) of the GABAA receptor a2, a4 and/or a5 subtype(s).

52. The method of treating, alleviating and/or preventing according to any one of items 31 to 49, wherein said compound further provides an agonistic effect on the effect of Y-aminobutyric acid (GABA) and/or any GABAA receptor modulating steroids (GAMS) on the GABAA receptor a2, a4 and/or a5 subtype(s) or wherein said compound further provides an agonistic effect on the effect of Y-aminobutyric acid (GABA) on the GABAA receptor a2, a4 and/or a5 subtype(s).

53. Use of a compound according to any one of items 1 to 6, or a pharmaceutically acceptable salt, hydrate, prodrug or solvate thereof in the preparation of a medicament for treating, alleviating and/or preventing a of a steroid-related CNS disorder, an autoimmune disease, and/or diabetes.

54. Use of a compound according to item 53, wherein said medicament is a medicament for treating, alleviating and/or preventing a of a steroid-related CNS disorder and said steroid-related CNS disorder is selected from the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes; pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholims; substance use disorder; relapses into alcohol and/or substance use disorder; epilepsy; menstruation cycle dependent epilepsy; seizure disorder; worsening of Petit Mai epilepsy; memory disturbance; learning disturbance; menstrual cycle linked memory changes; stress related memory changes; stress related learning difficulties; hepatic encephalopathy; Down’s syndrome; Alzheimer’s disease; depression; stress related depression; premenstrual syndrome; premenstrual dysphoric disorder; menstrual cycle linked mood changes; negative mood such as tension, irritability and depression; migraine; menstrual cycle linked migraine; stress linked migraine; hypersomnia and in particular stress related hypersomnia; sedation; idiopathic hypersomnia; sleep disorders; fatigue syndrome; burn-out syndrome; menstrual cycle linked sleep disorders; attention disorders; menstrual cycle linked difficulties in concentration; ADHD; mobility disorders; essential tremor; Tourette’s syndrome; balance disturbances; disturbance of motor function; and clumsiness.

55. Use of a compound according to any one of items 53 to 54, wherein said CNS disorder or disease, autoimmune disease and/or diabetes is associated with an a3 subtype of the GABAA receptor, such as the a3(32y2 subtype of the GABAA receptor.

56. Use of a compound according to any one of items 53 to 55, wherein said steroid-related CNS disorder or disease is selected from the group consisting of hyperphagia disorder; obesity; Prader-Willi’s syndrome; and polycystic ovarian syndrome; increased appetite disorder; obesity in diabetes, pathological food cravings; hypothalamic obesity; Cushing’s syndrome; hyperphagia disorder associated with injury to the hypothalamus; alcoholism, substance use disorder; relapses into alcohol and/or substance use disorder.

57. Use of a compound as defined in any one of items 1 -6 or a cosmetically acceptable salt, hydrate, precursor or solvate thereof for non- therapeutic prevention and/or reduction of overweight.

58. Use of compound according to item 57, wherein said prevention or reduction of overweight is in a subject having a BMI<30.

59. Use of compound according to item 57 or 58, wherein overweight defined as a BMI in the range of 25-29.9.

60. Method of preventing or reducing overweight in a subject comprising administering a cosmetically effective amount of compound according to any one of claims 1 to 6 or a cosmetically acceptable salt, hydrate, precursor or solvate thereof. 61 . Method of preventing or reducing overweight according to item 60, wherein said prevention or reduction of overweight is in a subject having a BMI<30.

62. Method of preventing or reducing overweight according to item 60 or 61 , wherein said overweight is defined as a BMI in the range of 25-29.9.

63. The use according to any one of items 57-59 or the method of preventing or reducing overweight according to any one according to items 60 to 62, wherein a decrease in bodyweight is seen after 1 to 20 days, such as after 3 to 15 days, such as after 5 to 10 days.

64. A cosmetic composition comprising a cosmetically effective amount of a compound selected from the group consisting of

3a-ethyl-3[3-hydroxy-5a-pregnan-20-one as shown in Formula 1 , and

3a-ethyl-3[3-hydroxy-5a-androstan-17-one as shown in Formula 2 or a cosmetically acceptable salt, hydrate, precursor or solvate thereof and at least one cosmetically acceptable excipient.