A Phase 3, Multicenter, Randomized, Double-blind, Placebo-controlled, Parallel-group Trial to Evaluate the Efficacy and Safety of NLS-2 (Mazindol Extended-Release) Tablets in the Treatment of Narcolepsy Type 1

The goal of this clinical trial is to see how NLS-2 (mazindol extended-release) works on symptoms of narcolepsy, including cataplexy and excessive daytime sleepiness.
Approximately 48 participants will take part in the study across the United States.
The study treatment (NLS-2 or placebo) will be administered for 8 weeks. After this treatment period, the participant may have the option to participate in a separate long-term extension study during which all participants will be treated with NLS-2.

开始日期2024-07-15

申办/合作机构

NLS Pharmaceutics Ltd.

NCT05055024 / Completed临床2期

A 6-Month Multicenter, Open-Labelled Extension of the Clinical Trial NLS-1021 in Narcoleptic Patients With and Without Cataplexy

This is a multicenter, open-label extension of the clinical study NLS-1021, evaluating long-term safety, tolerability, pharmacokinetics (PK), and therapeutic response to treatment with NLS-2 in adult subjects with narcolepsy.

开始日期2021-10-26

申办/合作机构

NLS Pharmaceutics Ltd.

NCT04923594 / Completed临床2期

A Four-week, Double-blind, Placebo-controlled, Randomized, Multicenter, Parallel-group Study of the Safety and Efficacy of NLS-2 (Mazindol Extended Release) in Adults for the Treatment of Narcolepsy

This is a double-blind, randomized, placebo-controlled, multicenter trial of NLS-2 in adult patients with narcolepsy. The study will enroll approximately 60 patients and eligible patients will be treated to receive either NLS-2 or placebo for 4-weeks.

开始日期2021-09-13

申办/合作机构

NLS Pharmaceutics Ltd.

100 项与马吲哚相关的临床结果

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100 项与马吲哚相关的转化医学

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100 项与马吲哚相关的专利（医药）

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项与马吲哚相关的文献（医药）

2024-10-01·INTERNATIONAL JOURNAL OF CLINICAL PHARMACOLOGY AND THERAPEUTICS

Rational use of short-term anorectic drugs for one-year effective treatment of obesity: An analysis of four studies

Article

作者: Rodríguez-Silverio, Juan ; Quiñonez-Bastidas, Geovanna Nallely ; Arrieta-Valencia, Jesús ; Mendoza, María Elena Sánchez ; Sánchez Mendoza, María Elena ; Galicia-Quintanar, Cynthia ; Reyes-García, Juan Gerardo ; Rocha-González, Héctor Isaac ; Barranco-Garduño, Lina Marcela ; Huerta-Cruz, Juan Carlos

BACKGROUND:

Obesity is a complex disease for which pharmacotherapy is often used. Anti-obesity drugs (AODs) are characterized by inducing a variable inter-subject body weight reduction (BWR), the attainment of a plateau after their maximal effect is achieved, and weight regain after drug discontinuation, which complicate individualized treatment of obesity.

OBJECTIVE:

This exploratory analysis aimed to compare the first-month body weight reduction in kg (1mo-BWRkg) and tolerance development (moT) of four known interventions with low (placebo), intermediate (phentermine or mazindol monotherapy), and high (5 active ingredients fixed-dose combination) efficacy, as predictors of their 6-month body weight reduction efficacy in percent (6mo-BWR%). In addition, a detailed analysis of the 6-to-12-month BWR follow-up in subjects under orlistat or diet and exercise regimens was performed.

MATERIALS AND METHODS:

The analysis included 662 adult subjects with obesity. After the construction of average efficacy and weight rebound curves, subjects were grouped into various 1mo-BWRkg, moT, and 6mo-BWR% intervals, or 6-month body weight rebound parameters for further evaluation.

RESULTS:

The 6mo-BWR% efficacy level of interventions was confirmed, although a general high intersubject variation was observed. 1mo-BWRkg + moT was found as an acceptable predictor of 6mo-BWR%. Between 50 and 80% of the 6-to-12-month follow-up completers maintained at least 5% BWR%.

CONCLUSION:

Short-term AODs are useful adjuvants for the 1-year rational treatment of obesity. 1mo-BWRkg + moT is an acceptable parameter to predict the 6mo-BWR% efficacy of these interventions.

2024-09-01·ADVANCES IN THERAPY

Clinical Efficacy and Safety of Anti-Obesity Medications Among Adult East Asian People with Obesity: A Systematic Literature Review and Indirect Treatment Comparison

Review

作者: Ota, Riku ; Matsuda, Hiroyuki ; Yokote, Koutaro ; Filomeno, Ronald ; Wada, Shogo

INTRODUCTION:

The prevalence of obesity has increased worldwide over the past decades. Regional variations exist in the relationship between body mass index (BMI), body fat, and health risks: Asians typically have a lower BMI than people of European descent, but a higher risk of obesity-related comorbidities. However, there is a paucity of evidence for anti-obesity medications (AOMs) in East Asian populations. In this study, we aimed to systematically review evidence regarding the safety and efficacy of AOMs among adults with obesity disease in East Asia, and to assess the feasibility of conducting an indirect treatment comparison (ITC) between the semaglutide and mazindol trials.

METHODS:

The Embase, MEDLINE, and ICHUSHI databases were searched via the Ovid SP platform for randomized controlled trials, in English or Japanese, reporting data on semaglutide or mazindol therapy with placebo or diet and exercise as comparators. The potential risks of bias in conducting a population-adjusted ITC were determined based on the heterogeneity of potential effect modifiers and variations in study design.

RESULTS:

Of 21 publications, 2 were included in this study based on the eligibility criteria. The STEP 6 study established the clinical efficacy of subcutaneous semaglutide compared with placebo in the reduction of body weight and cardiometabolic risk factors [glycated hemoglobin (HbA_1c), total cholesterol, and systolic blood pressure] among Japanese and South Korean people with obesity disease. Mazindol also proved beneficial in reducing body weight and total cholesterol compared with placebo in Japan. Both semaglutide and mazindol were associated with higher rates of adverse events and treatment discontinuation than placebo. An ITC between the two studies was not deemed feasible based on the potential risks of bias.

CONCLUSIONS:

Semaglutide and mazindol are associated with significant body weight reduction among people with obesity in East Asia. Further research based on label indications and up-to-date real-world data among East Asian people with obesity would help determine additional clinical benefits.

2022-12-01·Food research international (Ottawa, Ont.)

RNA-seq based elucidation of mechanism underlying the protective effect of Huangshui polysaccharide on intestinal barrier injury in Caco-2 cells

Article

作者: Li, Mei ; Wang, Ying ; Sun, Weizheng ; Huo, Jiaying ; Huang, Mingquan ; Wei, Jinwang ; Hao, Wenjun ; Wu, Jihong

Polysaccharides from Huangshui (HS) have the function of antioxidant and immunoregulation, but its intestinal barrier protection activity and the underlying mechanism remains unclear. The present work mainly studied the intestinal barrier protection function and its potential molecular mechanism of a heteropolysaccharide named NLS-2 with a molecular weight of 51.9 kDa. NLS-2 reduced intestinal permeability by decreasing the content of inflammatory cytokines and increasing the expression of tight junction (TJ) protein in LPS-damaged Caco-2 cells, thus protecting the intestinal barrier function. RNA-seq results showed that the differentially expressed genes (DEGs) were mainly enriched in the signaling pathways of MAPK, Toll-like receptor, and NF-κB. Subsequent western blot validation experiments proved that NLS-2 could indeed inhibit the two pathways of MAPK and NF-κB by reducing the expression of TRL4, thereby down-regulating the release of downstream pro-inflammatory cytokines and playing the role of intestinal barrier protection. Collectively, NLS-2 has beneficial effects on LPS-damaged intestinal barrier by inhibiting the TRL4/MyD88/NF-κB and MAPK signaling pathways.

项与马吲哚相关的新闻（医药）

2024-10-24

·Pharmaceutical Technology

Opioid treatment market set to grow despite expected slump in US sale value

Oxycodone is the generic name for a range of commonly-prescribed opoid pain killing tablets. Credit: Steve Heap / Shutterstock. The opioid addiction treatment market will be worth $2.4bn in eight major world markets by 2033. This is according to GlobalData, Pharmaceutical Technology ’s parent company, which forecasts that the market will grow at a compound annual rate (CAGR) of 1.8% from $2.0bn in 2023 to $2.4bn in 2033. The growth is set to be driven primarily by an increase in diagnosed prevalent opioid use disorder (OUD) cases and an increase in treatment rates across the eight major markets: the US, France, Germany, Italy, Spain, the UK, Canada, and Australia. However, GlobalData’s recent report, Opioid Addiction: Opportunity Assessment and Forecast , points out that market size is likely to see further growth as a result of the introduction of four late-stage pipeline products: cannabidiol, mazindol controlled release (CR), probenecid, and TRV-734. These products could push combined sales in the eight major markets to around $171.4mn by 2033. The biggest market is in the US which, due to its large patient population and expensive medications, constituted 74.1% of sales across the eight major markets in 2023. Jos Opdenakker, neurology analyst at GlobalData, said: “Of the four late-stage pipeline products, three of them (cannabidiol, mazindol CR, and probenecid) are non-opioids. Cannabidiol and mazindol CR are expected to be used as potential adjunctive treatments in addition to the standard of care in the treatment of opioid use disorder, driving an increase in the OUD market. Probenecid is indicated for the treatment of OWS [opioid withdrawal syndrome] and is expected to take market share from existing OWS agents.” See Also: Transforming CML patient monitoring with ICON’s innovative RNA-based NGS assay CPHI Europe: how AI can drive growth in the nutraceutical space The report highlights Trevena ’s TRV-734 as the product to watch: the pipeline product will be used in medication-assisted therapy for the treatment of OWS. Similar to other treatments, it targets the mu receptor, eliciting the partial effects of opioids to limit the side effects of withdrawal, which are often associated with opioid-based treatments. It could generate global sales of approximately $77.6m by 2033. However, Opdenakker added: “While the OUD pipeline agents will bring new mechanisms to market, they are unlikely to become first-line treatments. The need for effective non-opioid treatments that do not target the mu receptor, which could potentially replace opioids as first-line therapies, remains.” GlobalData’s forecast also expects the US market to shrink as a percentage of the overall market, estimating that the percentage of sales attributable to the US market will drop to 70.5% of the eight major markets by 2033. This is due to generic erosion, and the impending expiration of several patents ahead of 2033. Indivior ’s extended-release formulation of buprenorphine, Sublocade, was the top-selling drug in the opioid addiction market in 2023; its patent will expire in June 2031. Also set to expire during the forecast period are Alkermes ’ Vivitrol (naltrexone ER), Braeburn’s long-acting buprenorphine product, Brixadi and Orexo US’ Zubsolv (buprenorphine). Opdenakker concluded: “Although the impending entry of numerous generic products will act as a major barrier to growth and the introduction of the late-stage pipeline products is limited in their potential to generate significant revenues to counter the generic erosion, the increase in diagnosed prevalence, treatment rates, and general awareness surrounding opioid addiction will continue to act as the main drivers of growth across the eight major markets.”

2024-10-21

·BioSpace

NLS Pharmaceutics Secures Key Patent in Japan for Mazindol ER in the Treatment of Heroin Dependence

ZURICH, SWITZERLAND / ACCESSWIRE / October 21, 2024 / NLS Pharmaceutics Ltd. (NASDAQ:NLSP)(NASDAQ:NLSPW) (“NLS” or the “Company”), a Swiss clinical-stage biopharmaceutical company dedicated to developing therapies for rare and complex central nervous system disorders, is pleased to announce that its Japanese patent application No. 2020-513594 has been granted. The patent covers the use of Mazindol ER (extended-release) for the treatment of heroin dependence, providing a new therapeutic strategy for opioid use disorder. “The development of mazindol as a treatment for substance use disorder could represent a significant breakthrough, offering new hope for patients battling addiction. It is crucial we align our strategy with the evolving landscape of pharmaceutical innovation in this area.” said Alex Zwyer, Chief Executive Officer of NLSP. “This application highlights the continued commitment from NLS to pioneer therapeutic approaches to address significant unmet medical needs.” Key Highlights of this Patent Mazindol ER for Heroin Dependence : Mazindol, a tetracyclic compound with unique pharmacological properties, has shown promising in vivo results in reducing heroin dependence by modulating neurotransmitter systems involved in reward signaling and addiction pathways. The patent protects the use of Mazindol ER as a treatment for opioid addiction, specifically targeting heroin, one of the most potent and addictive opioids. Mechanism of Action : Unlike traditional opioid agonists and antagonists, Mazindol works by indirectly modulating the reward systems of the brain, targeting opioid receptors such as μ-opioid, κ-opioid, and δ-opioid receptors. By influencing these receptors, Mazindol reduces cravings and compulsive drug-seeking behaviors, helping to mitigate the effects of opioid use disorder without inducing the same level of dependence associated with other treatments. Focus on Long-Term Efficacy : The patent includes claims for the sustained-release formulation of Mazindol, which allows for a steady release of the drug over time, improving patient compliance and reducing the risk of relapse. This extended-release formulation is designed to maintain therapeutic levels of the drug in the bloodstream for prolonged periods, providing more consistent symptom management for individuals recovering from heroin addiction. Scientific Basis Opioid Use Disorder (OUD), particularly heroin addiction, poses a significant public health challenge worldwide. Heroin binds strongly to opioid receptors in the brain, leading to intense euphoria followed by physical dependence and withdrawal symptoms. Traditional treatments often rely on opioid substitution therapies, which can carry their own risks of dependence. Mazindol offers an innovative, non-opioid approach that addresses the brain’s addiction circuitry, potentially reducing the risk of relapse and improving recovery outcomes. The unique effect of Mazindol on heroin dependence lies in its ability to regulate the meso-corticolimbic system, which includes the ventral tegmental area (VTA) and nucleus accumbens-key regions in the brain’s reward circuitry. By normalizing these pathways, Mazindol helps reduce the compulsive behaviors associated with opioid use disorder, offering hope for individuals struggling with heroin addiction. Appeal Decision in Japan NLS Pharmaceutics successfully appealed the original rejection of its patent application, receiving a favorable decision from the Japan Patent Office (JPO) on October 2, 2024. The granted patent, which includes eight claims, provides robust protection for Mazindol ER and its specific use in treating opioid dependence, particularly heroin addiction. This decision reflects an innovative contribution to addiction medicine and positions Mazindol ER as a potentially transformative treatment for heroin dependence in Japan and beyond. About NLS Pharmaceutics Ltd. NLS Pharmaceutics Ltd. is a global development-stage biopharmaceutical company working with internationally recognized scientists and world-class partners to develop innovative therapies for patients with rare and complex central nervous system disorders. Headquartered in Switzerland and founded in 2015, NLS is led by an experienced management team with a track record of successfully developing and commercializing product candidates. For more information, visit . Safe Harbor Statement This press release contains forward-looking statements pursuant to U.S. Federal securities laws. For example, NLS discusses potential benefits of its products and the granted patent. Forward-looking statements are based on the current expectations of NLS management and are subject to numerous factors and uncertainties that could cause actual results to differ. These factors include technology changes, delays or obstacles in launching clinical trials, and the non-approval of NLS products by regulatory agencies. NLS undertakes no obligation to update any forward-looking statements to reflect events or circumstances after the date of this release unless required by law. Detailed risk information is included in NLS’s filings with the U.S. Securities and Exchange Commission (SEC), available at . Contact: Investor Relations Contact InvestorRelations@nls-pharma.com SOURCE: NLS Pharmaceutics AG View the original press release on accesswire.com

专利到期

2024-08-31

·药精通Bio

深度长文 | 难成药靶点c-Myc征途漫漫

TIS2024第四届自免疾病细胞疗法与干细胞疗法论坛重磅来袭，点击图片查看重磅嘉宾，合作详询：王晨 180 1628 8769 （扫码立即报名获取TIS2024免费票）编者注：本篇为VVIP投稿~ 2022年11月11日，Nature Review Drug Discovery的一篇新闻稿“Climbing cancer’s MYC mountain”对Omomyc I期临床结果的报道，让靶向c-Myc的药物研发重回大众的视野[1]。图1：c-Myc/Max 异二聚体- E-box DNA的复合物结构[1] Myc蛋白（又称c-Myc）在70%的肿瘤中表达失调，靶向失调的Myc蛋白有广泛的治疗作用。Myc作为转录因子，是一种固有无序蛋白，单独的Myc蛋白没有稳定的构象和适合小分子结合的位点，也是难成药代表性靶点。Myc蛋白自身稳定性较差，只有结合Max后才具有稳定构象，形成Myc-Max复合物后（图1），与DNA上的E-box序列结合启动下游基因转录[2]。直接靶向Myc蛋白有一定难度，因此，除了直接靶向Myc通路的Myc-Max相互作用和抑制Myc-Max复合物与DNA的相互作用外，间接调控Myc上下游通路也是治疗Myc相关疾病的重要方法。今天我们就来细说一下这些具有不同modality的Myc抑制剂的研究进展，扒一扒哪些公司在挂羊头卖狗肉，蹭Myc的热点。目前已有三款药物进入临床研究（Omomyc/PC002/WBC100），多款药物处于临床前研发阶段，药物形式也多种多样，涉及小分子抑制剂、多肽、Protac、分子胶等。 Omomyc 作为本轮热点的“始作俑者”，不得不先说说Omomyc。Soucek教授将c-Myc leucine zipper域中四个极性带电残基（E/E/R/R）突变为中性氨基酸（T/I/Q/N）得到含有91个氨基酸的工程肽Omomyc（图2），Omomyc可以自身二聚，也可以结合内源性Myc，阻断Myc-Max复合物与DNA-Ebox的相互作用，同时Omomyc也能够结合Max蛋白，阻断Myc-Max的相互作用（图3），进而促进内源性Myc蛋白的降解，抑制Myc下游基因转录发挥治疗作用[2]。图2：Omomyc的序列 OMO-103是基于Omomyc衍生化的细胞穿膜肽，2021年4月启动了一项针对晚期实体瘤的I期临床试验，用以评估其安全性、PK及有效性（NCT04808362）。入组的病人包括胰腺癌、肠癌和非小细胞肺癌等实体瘤病人，剂量从0.48 mg/kg爬坡到9.72 mg/kg，每周一次注射给药，RP2D=6.48mg/kg。截至到2022.10.10，给药9周后进行CT扫描的12名患者中，有8例病人中初步看到有效性（SD，stable disease），DLT是胰腺炎，其他不良反应多与静脉输液相关，安全性目前可接受。另外，临床前研究中发现，在小鼠肿瘤模型中瘤内药物浓度比血液中高四倍，人体PK显示给药50h后在血液里仍能检测到OMO-103，推测药物在人肿瘤中停留的时间可能更长[3]。 Omomyc/OMO-103在不同实体瘤中初步验证阻断Myc功能发挥治疗作用（虽然最好疗效是SD），安全性良好，应用肿瘤范围广，但是目前单药的治疗效果不够亮眼，未来在更大入组人数的表现、寻找合适的biomarker和亚组人群寻找、联用其他药物的结果值得期待。当然，小分子Myc抑制剂能否达到类似的安全性和有效性还有待进一步验证。图3：Omomyc的可能作用机制[2] PC-002 图4：PC-002结构临床进展最快的PC-002，又叫Sepantronium bromide（图4），是Cothera Bioscience（科赛睿生物/智康博药）开发用于治疗Myc基因异常淋巴瘤/神经母细胞瘤/神经内分泌前列腺癌的药物。目前正在进行针对高级别B细胞淋巴瘤的二期临床研究（NCT05263583）。Sepantronium bromide原先由Astellas Pharma开发，代号是YM-155，已经停止肿瘤临床开发。据科赛睿生物官网介绍，“PC-002是科赛睿生物公司的核心产品，是针对MYC基因变异肿瘤的first-in-class小分子药物。PC-002通过独特的作用机制（MOA）靶向MYC蛋白降解，选择性诱导MYC依赖的肿瘤细胞凋亡。PC-002以其独特的机理，选择性地杀伤具有MYC基因变异的肿瘤细胞，因而有望成为治疗多种癌症的重磅产品”[4]。经过检索发现“Sepantronium Bromide是一种有效的survivin抑制剂，通过抑制Survivin启动子活性而发挥作用”。Survivin作为一种抗凋亡蛋白，通常在肿瘤细胞中过度表达，介导肿瘤细胞逃避细胞凋亡，是潜在肿瘤治疗靶点。而c-Myc可以调节Survivin的转录，促进肿瘤的存活[5]。PC-002暂无公开证据表明其能直接靶向Myc而发挥功能，仅从科赛睿生物披露的机制来说，PC-002间接促进Myc的降解，临床选择人群也是Myc基因异常的肿瘤。其官网公开PC-002适应症人群而隐藏了靶点信息，有蹭热点的嫌疑。另外，PC002的化合物专利已经到期（WO 2001060803），科赛睿生物申请了联用和生物标记物专利（CN115605227），保护了PC002联用细胞周期阻滞剂治疗Myc相关肿瘤的用途。其临床前管线中还有一款基于PC-002改造的全新分子PC-002p用于治疗MYC+的肿瘤，可能也是Survivin抑制剂，专利暂未披露。 WBC100 图5：WBC100结构 WBC100是浙大医学院和第二军医大学联合开发的雷公藤甲素的缬氨酸酯衍生物。雷公藤甲素的靶点较多，尚未完全研究清楚其抗肿瘤机制，能够抑制包括NF-κB、HSF1、MDM2等多种靶点，对多种肿瘤细胞具有较强的增殖抑制作用。杭州卫本药业拥有WBC100的全球权利，已列入开发管线（wb001），目前处于I期临床研究阶段（CTR20211600）。2022年的一篇Adv. Sci.及专利WO2021208787报道WBC100是一种口服Myc分子胶，靶向c-Myc的NLS1-Basic-NLS2区域，通过E3泛素连接酶CHIP介导的26S蛋白酶体途径降解c-Myc蛋白，诱导肿瘤细胞凋亡，对多种c-Myc过表达的血液瘤和包括PDAC、NSCLC、HCC及CRC在内的实体瘤细胞有增殖抑制作用。并在极低剂量（0.1mpk）抑制c-Myc过表达AML、胰腺癌和胃癌肿瘤生长[9]。笔者并不质疑WBC100能够直接/间接/共价/非共价靶向c-Myc，但是从其结构来看，更相信Myc只是WBC100发挥抗肿瘤作用微不足道的靶点之一。WBC100结构中多个不稳定环氧丙烷结构的体内安全性也需慎重考虑。 GT-19077/GT-19715 苏州开拓药业管线中有两款靶向Myc的药物。其中，GT-19077是小分子Myc-Max蛋白-蛋白相互作用抑制剂，GT-19715是c-Myc/GSPT1双靶点降解剂，已经在IND阶段。图6：开拓药业专利中代表性结构与来鲁华课题组筛选的Myc抑制剂[6]及结构相似性cIAP1配体[7] 推测GT-19077可能来源于专利（WO2021004391/ WO2022089556），为含有硼酸或硼酸酯类的小分子化合物（图6），其结构基础推测是北大来鲁华课题组虚拟筛选出来的PKUMDL-YC-1205[6]。PKUMDL-YC-1205是Fmoc/Trt保护的天冬酰胺，看起来很是奇怪的一个分子，开拓将其保护基和氨基酸部分进一步改造，获得硼酸或硼酸酯类化合物。但是仔细推敲这些小分子，又像是cIAP1的配体[7]。含有硼酸或硼酸酯的小分子抑制剂可能是通过共价靶向c-Myc上的特定氨基酸增强与c-Myc的结合而发挥作用。图7：开拓药业专利中代表性结构及分子胶CC-885/CC-90009结构 GT-19715可能来源于开拓药业的降解剂专利（CN115504963/WO2022268066），分析其结构，似乎是在抑制剂基础上再加上Cereblon配体获得，但看起来更像是在GSPT1分子胶CC-90009/885的尾巴上加上Fmoc的类似基团（图7），不知是GT-19715降解谱筛选到了GSPT1，还是在分子胶的研发过程中加上了Myc抑制剂的结构。对于GT-19715是分子胶还是降解剂，开拓在不同的会议中定义不同，猜测GT-19715结构可能是CN115504963中化合物A153。从抑制剂和降解剂结构上看，虽然是宣传靶向Myc蛋白，但是脱靶风险非常高，当然降解剂已经明确是c-Myc/GSPT1双靶点。从多次会议公布的临床前药效模型来看， GT19630 (DC50=1.5 nM / IC50= 0.33 nM in HL-60；GT19715是 GT19630的盐型) ip给药在HL-60异种移植模型中有效地降解GSPT1，同时完全降解c-Myc，并在低剂量0.3 mg/kg/bid时抑制肿瘤生长，未引起体重明显下降，显示出良好的治疗效果和安全性。 GSPT1降解剂CC-90009的临床适应症也是AML/MS，临床前CC-90009对包括HL-60细胞在内的多种AML细胞具有亚纳摩级别抑制活性[8]。所以，在AML模型中GT19715发挥抑瘤作用究竟是降解Myc还是GSPT1所导致，抑或降解两个蛋白的协同作用，值得进一步探讨，毕竟在细胞增殖抑制中协同作用并不明显。开拓官方在多次会议中也披露GT19715能够抑制前列腺癌LNCap和耐药模型22RV-1肿瘤生长，并且能够促进AR-V7降解。同时，GT19715能够抑制小细胞肺癌细胞增殖和肿瘤生长，并促进c-Myc和N-Myc的降解。同一款分子胶或降解剂，在低浓度下，能够在不同肿瘤中促进包括c-Myc/N-Myc/GSPT1/GSPT2/CK1 alpha /IKZF1/AR-V7等多个蛋白的降解，笔者对这样一款超越分子胶或降解剂降解范围的分子的安全性不禁担忧。另外，不同于其他蛋白，Myc与Max蛋白间相互作用被阻断后，稳定性变差而降解，GT19715究竟是通过抑制Myc-Max蛋白-蛋白相互作用还是通过泛素-蛋白酶降解系统发挥作用，抑或是共同发挥作用，也是值得进一步验证。但是从公开数据来看，加入蛋白酶体抑制剂MLN9708能够抑制GT19715对Myc的降解，似乎泛素化降解发挥了一定作用。 ICX-101 ICX-101是Incurix开发的一种口服小分子Myc抑制剂，阻断c-Myc-Max异二聚体与DNA-E-box结合。官网披露EMSA/转录组实验验证了ICX-101对Myc具有选择性。 Incurix是韩国国立癌症中心下属子公司，主要研究肿瘤相关转录因子。韩国国立癌症中心专利（WO2012093741/WO2018021810/WO2018021849）显示其结构可能如图8所示，化合物51/56对包括膀胱癌、前列腺癌、肺癌、乳腺癌、白血病、胰腺癌、结直肠癌等肿瘤细胞的增殖抑制在μM级别，在肺癌（NCI-H1299）、前列腺癌（DU145）模型中抑制肿瘤生长。目前正在进行GLP和生物标记物研究，计划于2022年底进行临床试验，当前检索官网，仍未见临床消息。图8：WO2018021849专利中代表性分子 IDP-121/IDP-410 IDP Pharma 开发了两款肽类Myc抑制剂，其中IDP-121靶向c-Myc用于治疗c-Myc驱动肿瘤。IDP-410靶向N-Myc用于治疗脑胶，IDP-410能搜索到的数据较少。 IDP Pharma专利WO2019048679中披露了靶向c-Myc的拟肽S09、S14、IDP-P1708160和IDP-P1708161用于治疗多发性骨髓瘤（优选S09）。这些拟肽以c-Myc的一段基序为基础，通过“订书肽”形式维持野生肽的α-螺旋结构，增加其体内稳定性，阻断c-Myc与Max间形成复合物发挥抗增殖作用。专利数据显示这些拟肽在多种多发性骨髓瘤（MM）细胞系中具有μM水平的细胞毒作用，强于小分子抑制剂10058-F4，可作为单一药剂或与其他药物联合使用。体内外与标准疗法地塞米松和硼替佐米或环磷酰胺的药物的三联治疗中表现出协同抗肿瘤作用。目前IDP-121处于IND申请阶段，相较于野生型序列，IDP-121提高了稳定性，但在多发性骨髓瘤模型中单药抑瘤效果较差，与地塞米松、硼替佐米或环磷酰胺的二联或三联疗法中显示出显著的增强效果，临床首选适应症可能会是联用标准疗法用于标准疗法治疗失败的多发性骨髓瘤。图9：专利WO2019048679中代表性结构 c-Myc 蛋白表达抑制剂由于 c-Myc 蛋白缺乏稳定的构象和适合的小分子结合口袋，理性设计直接结合Myc的抑制剂具有较高挑战性。因此，也有一些biotech另辟蹊径，从c-Myc的转录和翻译入手，如Arrakis Therapeutics有一款靶向c-Myc mRNA的小分子，通过抑制c-Myc蛋白的表达，从而阻断Myc的功能，目前该项目正处于lead发现阶段。 Anima Biotech同样有一款c-Myc mRNA调节剂，专利WO2022150316披露一系列含硫三环结构分子，能够在细胞水平抑制c-Myc蛋白的翻译，代表性化合物332对c-Myc 依赖性A549肿瘤生长具有显著较强的抑制作用（3 mg/kg twice weekly，ip），目前该项目也处于lead优化阶段。图10：专利WO2022150316中分子332 c-Myc降解剂针对Myc这一难成药靶点，直接靶向Myc很难获得高亲和力分子，因此基于弱结合的抑制剂开发降解剂似乎是一个思路。蛋白降解领域的两家先驱Arvinas和Nurix Therapeutics均有一款靶向Myc的药物在临床前研发阶段，目前暂无专利披露。开拓GT19715究竟是Protac还是PPI抑制剂，抑或是c-Myc的分子胶，也还是值得进一步验证。笔者有个小疑问，c-Myc蛋白或mRNA半衰期低于半个小时，抑制剂干扰Myc-Max的相互作用后即可使Myc蛋白不稳定，促进降解，而在此基础上设计降解剂的有何更深层次的考虑？其他小分子 10074-G5和10058-F4是最早一批通过实验筛选发现的直接结合c-Myc蛋白的小分子，也是经分子水平、细胞水平和体内药效验证的c-Myc直接抑制剂。虽然存在荧光或典型的PAINS结构，这些化合物在分子水平通过FP、STD-NMR、2D-NMR、EMSA、CD等结合或竞争性实验验证能够直接结合在c-Myc上，并且明确10074-G5结合在c-Myc的aa363-481，10058-F4结合在aa404-412区域。通过直接结合在c-Myc蛋白上，进一步阻断Myc-Max的相互作用及Myc/Max复合物和DNA的相互作用。在细胞水平，这些分子能够抑制c-Myc依赖性的细胞增殖，下调c-Myc的转录活性，使细胞周期阻滞在G0/G1期等。由于筛选得到分子活性和理化性质不佳，研究者对10074-G5和10058-F4系列进行了多轮改造，3jc48-3的靶标活性和细胞活性略有提高，但是在体内药效并未体现出较优的抗肿瘤效果。但10074-G5和10058-F4结构简单，分子量较小，可作为苗头化合物进一步优化。化合物MICMI-6/7也经过分子、细胞及体内药效的验证，但是体内抗肿瘤效果一般，从其结构来看，都具有较大的刚性平面，且质子化能力较强，假阳性概率较高，不太适合进一步优化。 KDJ-Pyr-9这类联芳环结构与10074-G5结合在相同c-Myc蛋白序列，通过阻断Myc/Max-DNA相互作用抑制下游基因转录及细胞增殖，但分子刚性太强，分子量过大，有待于进一步优化。 Mycro1系列分子是基于Myc/Max-DNA的FP方法筛选出的化合物，对Myc-Max蛋白-蛋白相互作用具有较强的抑制作用，但对其他转录因子如CEBP/CEBP等的选择性较差。 MYCi361/975是基于已知c-Myc抑制剂构建药效团虚拟筛选、并进一步优化获得的c-Myc抑制剂，结合位点与10074-G5类似，这类分子是目前验证的较为充分的Myc抑制剂，从靶点结合到细胞增殖抑制、周期阻滞、Myc蛋白降解、下游基因转录抑制，系统验证了分子功能。但是此类分子的溶解度极差，单药抗肿瘤活性不强，成药性较差，有待于进一步优化。 KSI-3716是通过EMSA筛选得到的干扰c-Myc-Max复合物与DNA相互作用的小分子，同样能够抑制c-Myc的转录活性、细胞增殖及诱导细胞周期阻滞。KSI-3716本身具有较强的心脏毒性，因此后续开发了WO2018021849专利结构类似的含硫类分子。 Insilico在JPM2023最新披露的管线中也有一款在研c-Myc抑制剂，用于治疗肝癌，目前还处于discovery阶段。纵观这些早期研究中的小分子，整体上在靶标水平的结合能力不强，都在μM级别，细胞水平对多种c-Myc驱动肿瘤细胞增殖有抑制作用，但活性也不高，多数分子的溶解度、稳定性等理化性质不佳，这些分子多以iv或ip方式给药研究体内药效，在不同的肿瘤模型中，虽然展现出一定的抑瘤作用，但是效果一般，并未见到能消退肿瘤，多数分子的成药性较差。总结 c-Myc在多种肿瘤中表达异常，应用前景广阔。目前c-Myc直接抑制剂和间接抑制剂的开发尚处于早期阶段，已经发现的小分子抑制剂的成药性差，不足以支撑临床研究，亟待发现成药性更优的抑制剂。无序蛋白的药物开发有很大困难，许多biotech/AI制药公司把c-Myc这类难成药靶点作为管线开发，利用自家的平台优势，挑战难成药靶点药物的开发，一定会推动c-Myc抑制剂的研究进展。不过换个角度来看，虽然c-Myc在70%的肿瘤中表达失调，但是异常表达的c-Myc是肿瘤的直接驱动因素还是肿瘤发生发展的一个表现？开发c-Myc抑制剂能否在临床上对多种c-Myc失调的肿瘤有治疗效果？c-Myc抑制剂开发的高难度是否与其临床价值所匹配？相信随着越来越多的企业开始关注c-Myc抑制剂的开发，上述问题终将得到解答。参考文献 [1] Mullard A. Climbing cancer's MYC mountain. Nat Rev Drug Discov. 2022 Dec;21(12):865-867. [2] Madden SK, de Araujo AD, Gerhardt M, Fairlie DP, Mason JM. Taking the Myc out of cancer: toward therapeutic strategies to directly inhibit c-Myc. Mol Cancer. 2021 Jan 4;20(1):3. [3]http://www.peptomyc.com/results-revealed-from-phase-i-clinical-trial-of-the-first-drug-to-successfully-inhibit-the-myc-gene-which-drives-many-common-cancers/ [4] http://www.zkbymed.com/Index/Index/zixuncont/id/133 [5] Haque R, Song J, Haque M, Lei F, Sandhu P, Ni B, Zheng S, Fang D, Yang JM, Song J. c-Myc-Induced Survivin Is Essential for Promoting the Notch-Dependent T Cell Differentiation from Hematopoietic Stem Cells. Genes (Basel). 2017 Mar 6;8(3):97. [6] Yu C, Niu X, Jin F, Liu Z, Jin C, Lai L. Structure-based Inhibitor Design for the Intrinsically Disordered Protein c-Myc. Sci Rep. 2016 Mar 2;6:22298. [7] Shibata N, Nagai K, Morita Y, Ujikawa O, Ohoka N, Hattori T, Koyama R, Sano O, Imaeda Y, Nara H, Cho N, Naito M. Development of Protein Degradation Inducers of Androgen Receptor by Conjugation of Androgen Receptor Ligands and Inhibitor of Apoptosis Protein Ligands. J Med Chem. 2018 Jan 25;61(2):543-575. [8] Surka C, Jin L, Mbong N, Lu CC, Jang IS, Rychak E, Mendy D, Clayton T, Tindall E, Hsu C, Fontanillo C, Tran E, Contreras A, Ng SWK, Matyskiela M, Wang K, Chamberlain P, Cathers B, Carmichael J, Hansen J, Wang JCY, Minden MD, Fan J, Pierce DW, Pourdehnad M, Rolfe M, Lopez-Girona A, Dick JE, Lu G. CC-90009, a novel cereblon E3 ligase modulator, targets acute myeloid leukemia blasts and leukemia stem cells. Blood. 2021 Feb 4;137(5):661-677. [9] Xu Y, Yu Q, Wang P, Wu Z, Zhang L, Wu S, Li M, Wu B, Li H, Zhuang H, Zhang X, Huang Y, Gan X, Xu R. A Selective Small-Molecule c-Myc Degrader Potently Regresses Lethal c-Myc Overexpressing Tumors. Adv Sci (Weinh). 2022 Mar;9(8):e2104344. END 免责声明：本文仅作知识交流与分享及科普目的，不涉及商业宣传，不作为相关医疗指导或用药建议。文章如有侵权请联系删除。 TIS2024第四届免疫细胞疗法与干细胞疗法论坛重磅来袭，合作详询：王晨 180 1628 8769

临床结果AACR会议临床1期蛋白降解靶向嵌合体细胞疗法

100 项与马吲哚相关的药物交易

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KEGG	Wiki	ATC	Drug Bank
-	马吲哚	A08AA05	DB00579

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适应症	国家/地区	公司	日期
肥胖	美国	Novartis Pharmaceuticals Corp.	1973-06-14

未上市

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适应症	最高研发状态	国家/地区	公司	日期
发作性睡病1型	临床3期	-	NLS Pharmaceutics Ltd.	2024-07-15
注意缺陷障碍伴多动	临床2期	美国	NLS Pharmaceutics Ltd.	2023-04-27
发作性睡病	临床2期	意大利	NLS Pharmaceutics Ltd.	2022-03-16
猝倒症	临床2期	美国	NLS Pharmaceutics Ltd.	2021-09-13
白天过度嗜睡	临床2期	美国	NLS Pharmaceutics Ltd.	2021-09-13
特发性睡眠过度	临床前	美国	NLS Pharmaceutics Ltd.	2022-10-31

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研究	分期	人群特征	评价人数	分组	结果	评价	发布日期


NCT02808104 (Pubmed \| CNS Drugs) 人工标引	临床2期	注意缺陷障碍伴多动	85	mazindol	齋遞鬱構壓襯醖範鹹鹽(鬱願繭醖願餘鏇糧淵廠): LSMD = -13.2 更多	积极	2018-03-01
				Placebo