SECRETION FOR TREATING AATD

The invention relates to a composition comprising 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid, uses thereof and uses of 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid.

Oi -Antitrypsin (A1AT) is a member of the serpin superfamily produced by the liver and secreted into the blood. It inhibits a variety of serine proteases, especially neutrophil elastase. When blood levels of A1AT are low, excessive neutrophil elastase activity degrades lung tissue resulting in respiratory complications such as chronic obstructive pulmonary disease (COPD).

The reference range of A1AT in blood is 0.9-2.3 g/L. Levels lower than this are typical of a r antitrypsin deficiency (A1AD or AATD), a genetic disorder caused by mutations in the SERPINA1 gene, coding for A1 AT. The Z mutation, the most common cause of AATD, is the substitution of glutamate to lysine at position 366 of A1AT (UniProtKB - P01009 (A1AT HUMAN)), corresponding to position 342 in the mature protein (Z A1 AT). The Z mutation affects the folding of A1AT resulting in only a small fraction acquiring the native/active state. The remainder is either cleared as misfolded protein or accumulates in the liver as stable polymers. As a consequence of the misfolding, homozygous carriers of the Z mutation (ZZ) have plasma levels of A1 AT that are 10-15% of normal, predisposing carriers to COPD. Accumulation of Z A1AT polymers in liver cells predisposes carriers to cirrhosis, liver cancer and other liver pathologies.

The current treatment for the lung manifestation of AATD involves augmentation therapy using A1AT concentrates prepared from the plasma of blood donors. The US FDA has approved the use of four A1 AT products: Prolastin, Zemaira, Glassia, and Aralast. Dosing is via once weekly intravenous infusion. Augmentation therapy has been demonstrated to slow progression of COPD. The liver manifestations of AATD (e.g. cirrhosis and cancer) are treated with steroids and liver transplantation. Investigational approaches to improved treatment of the liver manifestations include inhibition of Z A1AT polymerisation and increased clearance of polymers through the activation of autophagy. Investigational approaches to improved treatment of both the lung and the liver manifestations are directed towards improvement of Z A1 AT folding and secretion.

Elliott et al (Protein Science, 2000, 9, 1274-1281) have described an X-ray crystal structure of A1AT and identified five cavities that are potential targets for rational drug design to develop agents that will affect Z A1 AT polymerisation.

Parfrey et al ( J. Biol. Chem., 2003, 278, 35, 33060-33066) have further defined a single cavity that is a potential target for rational drug design to develop agents that will affect Z A1AT polymerisation. Knaupp et al ( J. Mol. Biol., 2010, 396, 375-383) have shown that bis-ANS (4,4'-dianilino-1 ,1 binaphthyl-5, 5'-disulfonate) is able to bind to Z A1AT, but not to wild-type A1AT (M A1AT), with 1 :1 stoichiometry and a K _d of 700nM.

Chang et al ( J. Cell. Mol. Med., 2009, 13, 8B, 2304-2316) have reported a series of peptides, including Ac-TTAI-NH , that inhibit Z A1 AT polymerization.

Burrows ef a/ (Proc. Nat. Acad. Sci., 2000, 97, 4, 1796-1801) have shown that a series of non- selective chaperones, including 4-phenylbutyric acid, glycerol and trimethylamine oxide, are able to increase Z A1AT levels in cell supernatants and mouse models.

Bouchecareilh et al (Journal of Biological Chemistry, 2012, 287, 45, 38265-38278) describe the use of histone deacetylase inhibitors, in particular SAHA (suberoylanilide hydroxamic acid) to increase the secretion of both wild-type (M A1 AT) and Z A1 AT from cells.

Berthelier et al (PLOS ONE, May 11 , 2015) have demonstrated that S-(4-nitrobenzyl)-6- thioguanosine is able to prevent Z A1 AT polymerisation in vitro.

Mallya etal ( J. Med. Chem., 2007, 50, 22, 5357-5363) describe a series of phenols, such as N- (4-hydroxy-3,5-dimethylphenyl)-2,5-dimethylthiophene-3-sulfo namide, able to block polymerisation of Z A1 AT in vitro.

Huntington (Xlllth International Symposium on Proteinases, Inhibitors and Biological Control, 23 September 2012, and 7 ^th International Symposium on Serpin Biology, Structure and Function, 1 ^st April 2014) discussed a cavity from an X-ray crystal structure of Z A1 AT that is a potential target for rational drug design to develop agents that will affect Z A1 AT polymerisation.

US8,436,013B2 discloses a wide variety of structures able to increase secretion of Z A1 AT from cells in the micromolar range.

WO2019/243841 A1 describes compounds designed to inhibit ZA1 AT polymerisation by inducing formation of a cryptic binding site within the A1 AT protein structure.

W02020/081257A1 describes compounds which are able to modulate A1AT activity, as measured using a Z A1 AT elastase activity assay.

Compounds with CAS registry numbers 1797054-78-4 and 1219580-65-0 are listed in the Aurora Building Blocks catalogue. US2007/0167621 A1 describes substituted pyrimidinones including 4-{[4-[(2,4- difluorobenzyl)oxy]-2-methyl-6-oxopyrimidin-1 (6H)-yl]methyl}benzoic acid and their use in treating diseases and conditions caused or exacerbated by unregulated p38 MAP kinase and/or TNF activity.

In a first aspect of the present invention there is provided a composition comprising 4-((6- oxopyrimidin-1 (6H)-yl)methyl)benzoic acid.

The compound 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid is represented by formula I:

The composition may be a pharmaceutical composition, for example a human pharmaceutical composition or a veterinary pharmaceutical composition.

The composition may further comprise a pharmaceutically or therapeutically acceptable excipient or carrier.

The term “pharmaceutically or therapeutically acceptable excipient or carrier” refers to a solid or liquid filler, diluent or encapsulating substance which does not interfere with the effectiveness or the biological activity of the active ingredients and which is not toxic to the host, which may be either humans or animals, to which it is administered. Depending upon the particular route of administration, a variety of pharmaceutically acceptable carriers such as those well known in the art may be used. Non-limiting examples include sugars, starches, cellulose and its derivatives, malt, gelatin, talc, calcium sulfate, vegetable oils, synthetic oils, polyols, alginic acid, phosphate buffered solutions, emulsifiers, isotonic saline, and pyrogen-free water.

All suitable modes of administration are contemplated according to the invention. For example, administration of the composition may be via oral, subcutaneous, direct intravenous, slow intravenous infusion, continuous intravenous infusion, intravenous or epidural patient controlled analgesia (PCA and PCEA), intramuscular, intrathecal, epidural, intracistemal, intraperitoneal, transdermal, topical, transmucosal, buccal, sublingual, transmucosal, inhalation, intranasal, intra-atricular, intranasal, rectal or ocular routes. The composition may be formulated in discrete dosage units and can be prepared by any of the methods well known in the art of pharmacy. All suitable pharmaceutical dosage forms are contemplated. Administration of the composition may for example be in the form of oral solutions and suspensions, tablets, capsules, lozenges, effervescent tablets, transmucosal films, suppositories, buccal products, oral mucoretentive products, topical creams, ointments, gels, films and patches, transdermal patches, abuse deterrent and abuse resistant formulations, sterile solutions suspensions and depots for parenteral use, and the like, administered as immediate release, sustained release, delayed release, controlled release, extended release and the like.

In a further aspect of the present invention, there is provided the composition as set out above for use as a medicament.

In a further aspect of the present invention, there is provided the composition as set out above for use in treating AATD.

It has been found that 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid is highly effective at increasing the levels of correctly folded and hence active Z A1 AT which means that 4-((6- oxopyrimidin-1 (6H)-yl)methyl)benzoic acid can be used to treat AATD.

The composition may treat AATD by inducing Z A1 AT secretion.

In a further aspect of the present invention, there is provided the composition as set out above for use as an inducer of Z A1 AT secretion. The use may be in vitro, for example in an in vitro assay.

In a further aspect of the present invention, there is provided the compound 4-((6-oxopyrimidin- 1 (6H)-yl)methyl)benzoic acid, for use as a medicament.

In a further aspect of the present invention, there is provided the compound 4-((6-oxopyrimidin- 1 (6H)-yl)methyl)benzoic acid for use in treating AATD.

The compound 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid may treat AATD by inducing Z A1AT secretion.

In a further aspect of the present invention there is provided the compound 4-((6-oxopyrimidin- 1 (6H)-yl)methyl)benzoic acid for use as an inducer of Z A1 AT secretion.

In a further aspect of the present invention, there is provided a use of the compound 4-((6- oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement set out above in the manufacture of a medicament. In a further aspect of the present invention, there is provided a use of the compound 4-((6- oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement set out above in the manufacture of a medicament for treating AATD.

The compound 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement set out above may treat AATD by inducing Z A1 AT secretion.

In a further aspect of the present invention there is provided a use of the compound 4-((6- oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement above in the manufacture of a medicament for inducing Z A1 AT secretion.

In a further aspect of the present invention, there is provided a method of treating AATD, comprising administering to a subject 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement set out above.

The method may comprise the 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement above inducing Z A1 AT secretion.

In a further aspect of the present invention, there is provided a method of inducing Z A1 AT secretion comprising administering to a subject 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid or the composition according to any statement set out above.

In a further aspect of the present invention, there is provided a use of 4-((6-oxopyrimidin-1 (6H)- yl)methyl)benzoic acid or the composition according to any statement set out above as an inducer of Z A1 AT secretion. The use may be in vitro, for example in an in vitro assay.

Administration of the composition as set out above or the compound 4-((6-oxopyrimidin-1 (6H)- yl)methyl)benzoic acid may be via oral, subcutaneous, direct intravenous, slow intravenous infusion, continuous intravenous infusion, intravenous or epidural patient controlled analgesia (PCA and PCEA), intramuscular, intrathecal, epidural, intracistemal, intraperitoneal, transdermal, topical, transmucosal, buccal, sublingual, transmucosal, inhalation, intranasal, intra-atricular, intranasal, rectal or ocular routes.

As used herein, the term “comprising” is to be read as meaning both comprising and consisting of. Consequently, where the invention relates to a “pharmaceutical composition comprising as active ingredient” a compound, this terminology is intended to cover both compositions in which other active ingredients may be present and also compositions which consist only of one active ingredient as defined.

Unless otherwise defined, all the technical and scientific terms used here have the same meaning as that usually understood by an ordinary specialist in the field to which this invention belongs. Similarly, all the publications, patent applications, all the patents and all other references mentioned here are incorporated by way of reference in their entirety (where legally permissible).

Particular non-limiting examples of the present invention will now be described with reference to the following drawings and examples, in which:

Figure 1 is a graph showing the dose dependent effect of 4-((6-oxopyrimidin-1 (6H)- yl)methyl)benzoic acid in an in vitro Z A1 AT cell secretion assay using “HEK-Z” cells (i.e. HEK- EBNA cells containing the Z A1 AT plasmid). Vehicle and 10 mM SAHA were tested on each plate as controls. The x-axis shows various treatments of the cells: vehicle, SAHA and increasing concentrations of 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid, the y-axis is the concentration of Z A1 AT in the cell supernatant (in ng/ml).

Examples

Example 1 : Preparation of 4-((6-oxopyrimidin-1(6H)-yl)methyl)benzoic acid

4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid was prepared using the following sequential synthesis procedures.

(a) Synthesis of tert-butyl 4-((6-oxopyrimidin-1 (6H)-vhmethvhbenzoate

Pyrimidin-4(3H)-one (5g, 32 mmol) and caesium carbonate (50.85g, 156 mmol) were stirred in dimethylformamide (50ml) for 10 minutes at room temperature. Tert-butyl 4- (bromomethyl)benzoate (14.11 g, 52 mmol) was added and the reaction was stirred for 3 hours. The reaction was diluted with water and the resulting yellow precipitate collected by filtration. The crude product was purified by column chromatography on silica, eluting with ethyl acetate/hexane (30 % to 33%) to give tert-butyl 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoate. Tic Rf 0.2 1 :1 Ethyl acetate/hexane.

(b) Synthesis of 4-((6-oxopyrimidin-1 (6l-0-vhmethvhbenzoic acid

Tert-butyl 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoate (10g, 35 mmol) was dissolved in dichloromethane (50ml) and trifluoroacetic acid (70ml) was added slowly. The reaction was stirred for 3 hours at room temperature. The reaction was concentrated under reduced pressure and the resulting oil stirred with diethyl ether (300ml) for 20 minutes at room temperature. The resultant solid was collected by filtration, washed with diethyl ether (2 x 30ml) and dried in vacuo to give 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid. Example 2: Activity of 4-((6-oxopyrimidin-1(6H)-yl)methyl)benzoic acid in a Z A1AT cell secretion assay using HEK-Z cells

Methods

HEK-Z cells, a human embryonic kidney cell line stably transfected with the human Z A1AT gene, were plated into 96 well plates (3.0 x 10 ⁵ cells/ml with 200mI of media/well) overnight at 37 ^° C in a humidified atmosphere containing 5% CO2. Following incubation cells were washed with 200mI serum-free media three times and media was replaced with treatments in quadruplicate using vehicle, 10 mM suberanilohydroxamic acid (SAHA) or 4-((6-oxopyrimidin-1 (6H)- yl)methyl)benzoic acid (at concentrations of 10, 33, 100 and 333 nM) for 48 h in a 37 ^° C incubator in a final volume of 200 mI. At the end of the incubation step the supernatants were removed from the wells, centrifuged at 1000 xg at 4 ^° C for 10 min and were assayed for Z A1AT levels by ELISA (Human Serpin A1/oc1 -antitrypsin duo set ELISA, R&D Systems, DY1268) per manufacturer’s instructions.

Briefly, a 96 well plate was coated with human A1AT capture antibody overnight at room temperature (1 :180 dilution from stock, 100 mI final volume/well). The capture antibody was then removed and wells washed three times with 300 mI wash buffer (0.05% Tween 20 in PBS) and then 200 mI reagent diluent (25% Tween 20 in PBS) was incubated in each well for 1 h at room temperature. Samples, standards (125, 250, 500, 1000, 2000, 4000 and 8000 pg/ml A1AT) or blanks were then added to each well in duplicate and the plates were covered with a plate sealer and left at room temperature for 2 h. At the end of the sample incubation step, samples were removed and all wells washed as previously and 100 mI detection antibody(1 :180 dilution from stock) was added to each well and incubated for a further 2 h at room temperature. Following incubation with detection antibody, supernatant was removed and wells were washed as previously and 100 mI streptavidin-HRP solution (1 :200 dilution from stock) was added to each well for 20 min in the dark. After which, 50 mI stop solution (2M H2SO4) was added and optical density (OD) of each well was read at 450 nm with 570 nm blank subtracted from each well using a microplate reader. A 4 parameter logistic curve was constructed using GraphPad Prism 8 and Z A1 AT concentrations were determined in each sample by interpolation from a standard curve and multiplying by the appropriate dilution factor.

Results

The amount of Z A1 AT secreted from HEK-Z cells into the media was measured by ELISA. SAHA at 10 mM was used a positive control.

The data in Figure 1 show that 4-((6-oxopyrimidin-1 (6H)-yl)methyl)benzoic acid secretion of Z

A1 AT was increased in a dose dependent manner as measured by ELISA.