Novel Extended Release Glaucoma Therapy for Once Daily Dosing

青光眼是世界上导致不可逆性失明的主要原因。眼压升高是 导致视网膜神经节细胞(RGC)死亡并导致视野丧失的最重要的危险因素 原发性开角型青光眼。目前青光眼的治疗标准包括眼压治疗。 减少局部用药，如滴眼液。然而，许多患者继续失去视野。 尽管在服用降眼压药水。我们采取了全面的遗传学方法来寻找新药 可以解决当前疗法局限性的目标。我们已经证明了Cacna2d1是 特别是与老鼠和人类的高眼压有关。我们还证明了一个选择性的Cacna2d1 阻滞剂表现出强大的降眼压活性，可以最大限度地降低眼压，但不能达到40% 使用生物粘附性微乳剂时，可恢复到基线状态约33小时。我们还确定， CACNA2D1定位于CB、TM和RGC，这表明该蛋白的抑制剂可以降低 眼压和保护视网膜节细胞。最后，我们证明了眼压降低的程度与基因有关。 单倍型，从而展示了根据患者的基因特征量身定做治疗的潜力。我们的整体 目的是开发和验证一种或多种新的局部配方，以将有效的药物输送到 在每日一次的外用配方中抑制CACNA2D1。这一治疗策略将减轻患者的负担 耐心，提高依从性，并导致更好的视觉结果。我们的中心假设是一个小的 靶向CACNA2D1的分子--当在局部微乳中配制时--将引起眼压下降 在幅度和持续时间上比其他青光眼药物更好的反应。这方面的整体优势 建议包括：1)结合一个强大的跨学科团队；2)成功地利用 用遗传学方法确定阻止青光眼相关眼压和RGC升高的新药靶点 死亡；3)将我们的新药用于精确医学的潜力；4)开发和 使用缓释制剂优化创新的IOP输送策略。在这项提案中，我们 提供概念验证数据，并通过建立有效性来解决关键的可行性问题； 我们新型微乳治疗的药效学、生物相容性和生物分布。我们开发了一种 新型局部每日一次的微乳制剂作为一种新的青光眼治疗方法；测量 CACNA2D1抑制剂穿过角膜，确定眼内的药代动力学运动，并评估 体内生物分布；建立CACNA2D1抑制剂作为青光眼治疗药物的作用机制； 确定Cacna 2d1的单倍型是否影响对我们配方的降眼压反应(S)；以及 准备并向FDA提交IND申请。这些结果将使我们能够直接进入一个阶段 第二个示范项目，为第三阶段的商业化做准备。

Glaucoma is the leading cause of irreversible blindness in the world. Elevated intraocular pressure (IOP) is the most significant risk factor contributing to death of retinal ganglion cells (RGCs) and resulting visual field loss in primary open angle glaucoma (POAG). The current standard of care for glaucoma includes treatment with IOP- lowering medications delivered topically as eye drops. However, many patients continue to lose visual fields despite being on IOP-lowering drops. We have taken a comprehensive genetics approach to seek new drug targets that may address the limitations of current therapies. We have demonstrated that Cacna2d1 is specifically linked to high IOP both in mice and humans. We have also shown that a selective Cacna2d1 blocker exhibits potent IOP-lowering activity that can achieve a maximal IOP reduction >40% that does not return to baseline for ~33 hours when delivered by bioadhesive microemulsion. We have also determined that CACNA2D1 is localized to the CB, TM and RGCs, suggesting that inhibitors of this protein could both lower IOP and protect RGCs. Lastly, we have shown that the degree of IOP lowering is correlated with the gene haplotype, thus demonstrating the potential of tailoring treatment to a patient’s genetic profile. Our overall objective is to develop and validate one or more novel topical formulations to deliver the effective drugs to inhibit CACNA2D1 in a once daily topical formulation. This treatment strategy will reduce the burden to the patient, increase compliance and lead to better visual outcomes. Our central hypothesis is that a small molecule that targets CACNA2D1—when formulated in a topical microemulsion—will elicit an IOP-lowering response that is greater in amplitude and duration than other glaucoma medications. Overall strengths of this proposal include: 1) the combination of a strong interdisciplinary team; 2) the successful utilization of a genetics approach to identify a new drug target for blocking glaucoma-related increases in IOP and RGC death; 3) the potential for utilizing our novel drug for precision medicine and; 4) the development and optimization of an innovative IOP delivery strategy using an extended-release formulation. In this proposal, we provide proof-of-concept data and address key feasibility questions by establishing efficacy, pharmacodynamics, biocompatibility and biodistribution of our novel microemulsion treatment. We develop a novel topical once daily microemulsion formulation as a new glaucoma therapy; measure the movement of CACNA2D1 inhibitors across the cornea, determine pharmacokinetic movements in the eye and assess full- body biodistribution; establish the mechanism of action of CACNA2D1 inhibitors as glaucoma therapies; determine if the haplotype of Cacna2d1 influences the IOP-lowering response to our formulation(s); and prepare and submit an IND application to the FDA. These results will position us to proceed directly to a Phase II demonstration project in preparation for Phase III commercialization.