Development of a Potent and Highly Selective NaV1.7 Inhibitor for the Treatment of Acute Pain with the Goal of Reducing Opioid Use and Preventing Opioid Use Disorders

开发一种有效且高选择性的 NaV1.7 抑制剂，用于治疗急性疼痛，目标是减少阿片类药物的使用和预防阿片类药物使用障碍

• 批准号: 10025176
• 负责人: John Cureton Hunter
• 金额: $ 244.01万
• 依托单位: SITEONE THERAPEUTICS, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10025176
• 关键词: 12 year old; Absence of pain sensation; Acute; Acute Pain; Acute pain management; Adult; Afferent Neurons; Analgesics; Anesthesia and Analgesia; Animal Genetics; Animals; Anosmia; Award; Binding; Binding Proteins; Biological Assay; Buprenorphine; Chemicals; Clinic; Clinical; Clinical Trials; Collaborations; Congenital Pain Insensitivity; Data; Defecation; Development; Dose; Drug Kinetics; Drug Targeting; Drug usage; Erythromelalgia; Evaluation; Exhibits; Family; Female; Fentanyl; Flushing; Friends; Funding; Goals; Hernia; Hospitals; Human; Human Genetics; In Vitro; Individual; Inherited; Intravenous; Investigational Drugs; Investigational New Drug Application; Ions; Knock-out; Lead; Macaca fascicularis; Mammalian Cell; Metabolism; Methods; Minor; Missense Mutation; Monkeys; Morphine; Mus; Neurons; Nociceptors; Operative Surgical Procedures; Opioid; Pain; Pain Disorder; Pain Measurement; Pain intensity; Paroxysmal extreme pain disorder; Patients; Pattern; Peripheral; Pharmaceutical Preparations; Pharmacology Study; Phase; Phase I Clinical Trials; Phase II Clinical Trials; Phenotype; Postoperative Pain; Primates; Process; Program Development; Property; Protein Isoforms; Rattus; Reporting; Research; Safety; Series; Small Business Innovation Research Grant; Smell Perception; Sodium Channel; Soft Tissue Injuries; Spinal Ganglia; Stimulus; Structure; Sympathetic Ganglia; Tactile; Therapeutic; Toxic effect; Toxin; Validation; Variant; Visceral; Weight; Writing; absorption; acute care; addiction; base; behavior observation; clinical development; design; drug candidate; efficacy study; experience; gain of function; gain of function mutation; good laboratory practice; guanidinium; human subject; hydrophilicity; in vivo; inhibitor/antagonist; intravenous administration; loss of function mutation; male; nanomolar; non-opioid analgesic; nonhuman primate; novel; olfactory sensory neurons; opioid mortality; opioid overdose; opioid sparing; opioid use; opioid use disorder; overdose death; pain model; pain reduction; phase II trial; prescription opioid; prescription opioid misuse; prevent; programs; repaired; small molecule inhibitor; soft tissue; voltage; volunteer

Project Summary/Abstract In 2015, over 63% of drug overdose deaths involved an opioid of which nearly half involved a prescription opioid. While most opioid deaths and overdoses are likely due to illicitly-manufactured fentanyl, prescription opioid use for treatment of acute pain appears to be a gateway for development of opioid use disorders through prescribed or diverted use in patients or non-patients, respectively. Specifically, of the >70 million patients who receive prescription opioids for acute pain following minor or major surgery every year in the US, an estimated 6% go on to use opioids persistently. In 2016, 53% of individuals aged 12 years or older who reported non-medical use of prescription opioids obtained the misused/diverted medications from family or friends. Therefore, developing a non-opioid analgesic medication to manage acute, post-operative pain should reduce or replace opioid prescriptions and thereby prevent opioid use disorders. The voltage-gated sodium ion channel NaV1.7 is preferentially expressed in peripheral somatic and visceral sensory neurons within the dorsal root ganglion, including nociceptors, olfactory sensory neurons and sympathetic ganglion neurons. Global knockout of NaV1.7 in mice resulted in insensitivity to painful tactile, thermal and chemical stimuli and anosmia. A similar phenotype is observed in humans with congenital insensitivity to pain in whom loss-of-function mutations in NaV1.7 lead to an inability to experience most types of pain but have otherwise normal neuronal function except for loss of smell. In contrast, dominantly inherited gain- of function missense mutations of NaV1.7 are found in patients with erythromelalgia and paroxysmal extreme pain disorder, who report flushing and severe, episodic pain triggered by mild warmth or bowel movement. Based on these data, and the very low expression of NaV1.7 in the CNS, NaV1.7 inhibitors have the potential to decrease acute pain intensity without opioid-like addiction liability. At least five NaV1.7 inhibitors have been assessed in clinical trials, yet none has advanced beyond Phase 2. While this might be interpreted as evidence that inhibiting NaV1.7 is not sufficiently analgesic, attainment of clinically-meaningful levels of channel blockade is challenging. This is especially true with state-dependent inhibitors of NaV1.7 (PF-05089771, GDC-0276, GDC-0310), highly protein-bound drugs (PF-05089771), and drugs with low-to-moderate selectivity for NaV1.7 (XEN-402, CNV-1014802) where off-target interactions limit the dose that can be safely administered in clinic. ST-2427 is a novel, first-in-class, state-independent inhibitor of NaV1.7 with nonclinical data demonstrating its safety and acceptable pharmacokinetic properties, and its potential for superior efficacy to opioids. This proposal aims to complete IND-enabling research and conduct Phase 1 and Phase 2 clinical trials with ST-2427 for treatment of acute, post-operative pain, and an assessment of the potential to significantly reduce and/or eliminate opioid consumption.

项目总结/摘要 2015年，超过63%的药物过量死亡涉及阿片类药物，其中近一半涉及处方阿片类药物。 虽然大多数阿片类药物死亡和过量可能是由于非法制造的芬太尼， 用于治疗急性疼痛似乎是通过规定的阿片类药物使用障碍发展的途径 或分别在患者或非患者中转移使用。具体而言，在接受治疗的7000万患者中， 在美国，每年用于治疗小手术或大手术后急性疼痛的处方阿片类药物中，估计有6%用于 坚持使用阿片类药物。2016年，53%的12岁或12岁以上的人报告了非医疗用途， 的处方阿片类药物从家人或朋友那里获得滥用/转移的药物。因此开发 一种非阿片类镇痛药来管理急性，术后疼痛应减少或取代阿片类药物 处方，从而防止阿片类药物使用障碍。 电压门控钠离子通道NaV1.7优先表达于外周躯体和内脏 背根神经节内的感觉神经元，包括伤害感受器、嗅觉感觉神经元和 交感神经节神经元小鼠中NaV1.7的整体敲除导致对疼痛触觉不敏感， 热和化学刺激以及嗅觉丧失。在患有先天性心脏病的人类中观察到类似的表型。 对疼痛不敏感，NaV1.7的功能缺失突变导致无法经历大多数类型的疼痛。 疼痛，但除嗅觉丧失外，其他神经功能正常。相反，显性遗传的收益- 在红斑性肢痛症和阵发性肢痛症患者中， 疼痛障碍，他们报告潮红和严重的，由轻度温暖或排便引发的阵发性疼痛。基于 根据这些数据，以及NaV1.7在CNS中的非常低的表达，NaV1.7抑制剂具有降低 急性疼痛强度，无阿片样物质成瘾倾向。 至少有五种NaV1.7抑制剂在临床试验中进行了评估，但没有一种超过2期。 虽然这可能被解释为抑制NaV1.7并不足以镇痛的证据，但达到 具有临床意义的通道阻断水平是具有挑战性的。对于依赖状态的 NaV1.7抑制剂（PF-05089771、GDC-0276、GDC-0310）、高蛋白结合药物（PF-05089771），以及 对NaV1.7（XEN-402，CNV-1014802）具有低至中等选择性的药物，其中脱靶相互作用限制 临床上可以安全使用的剂量。 ST-2427是一种新型的、一流的、非状态依赖性的NaV1.7抑制剂，非临床数据表明其 安全性和可接受的药代动力学性质，以及其具有优于阿片类药物的上级功效的潜力。这项建议 旨在完成IND使能研究，并进行ST-2427的1期和2期临床试验， 治疗急性术后疼痛，并评估显著减少和/或 消除阿片类药物消费。