DNDI-0690: a new promising drug candidate for the treatment
of visceral leishmaniasisStéphanie Braillard, Béatrice Bonnet, Eric Chatelain
Drugs for Neglected Diseases initiative (DNDi), Geneva, Switzerland
WorldLeish 6
16 – 20 May 2017
Poster number C1568
Leishmania donovani / infantum transmitted by sand flies is the causative pathogenresponsible for visceral leishmaniasis (VL), a fatal disease present in eastern Africa, Indiaand Latin America. There are between 150,000 and 300,000 cases a year, 50% of whichare children. Few treatment options are available and all drugs suffer from significantdrawbacks, limiting their use in endemic countries. There is a clear need for novel drugsfor VL that are efficacious, affordable, better tolerated and safer than current treatments.We present here DNDI-0690, a 7-substituted nitroimidazooxazine compound, issued froma DNDi collaborative lead optimization effort which is currently undergoing formal pre-clinical development before moving to first in human trials in Q1 2018.
INTRODUCTION
PHYSICO-CHEMICAL PROPERTIESChirality
One stereogenic centre(R enantiomer)
Melting point (DSC) Peak temp ~205°C
pKa (measured) 3.95
Salt formationHCl selected among 4 identified (HCl, H2SO4, H3PO4
and MeSO3H)
ELogD pH 7.4 2.45 (racemate)
Thermodynamic Solubility (Free base) µg/ml
pH 1.2: 128
pH 7.4: 2
Water: 114
Solubility in organicsolvents at 20°C
DMSO (64.4 mg/mL)
AcOH, Acetone, 2-butanone,
THF: 3.8-9.2 mg/mL
Solubility FaSSIF/FeSSIF(µg/ml) at 4h
FaSSIF: 1.35
FeSSIF: 5.18
Polymorphic form Only one polymorphic form
Permeability MDCK/MDR1Papp (nm/s) A to B / B to A
29.15 / 26.17 (no efflux)
XRPD Crystalline material
Polarized Light Microscopy
Irregular small crystalline particles
UV absorption 255 nm (λmax)
Hygroscopicity non hygroscopic
PROCESS ROUTE5 convergent steps (Overall yield~16%).Validated up to 4kg scaleHigh HPLC and chiral purity material (>99%)
ADME PROFILE
CONCLUSION AND PERSPECTIVES
PHARMACODYNAMIC PROFILE
Contact
N
N
Cl
O2N
O
2-chloro-4-nitro-1-[2-(oxiran-2-yl)ethyl]-1H-imidazole
C7H8ClN3O3
MW 217.61
rac-9N
N
Cl
O2N
O
2-chloro-4-nitro-1-{2-[(2R)-oxiran-2-yl]ethyl}imidazole
C7H8ClN3O3
MW 217.61
(R,R)Co(III)(OAc)Salen chiral-9
(R,R)Co(II)SalenO
Br
rac 2-(2-bromoethyl)oxirane
C4H7BrO
MW 151.00
NH
N
Cl
O2N
2-chloro-4-nitro-1H-imidazole
C3H2ClN3O2
MW 147.52
N Br
OH
C5H4BrNO
MW: 173.995
6-bromopyridin-3-ol
F
BOH
OH
N
OH
F
C11H8FNO
MW:189.186
6-(4-fluorophenyl)pyridin-3-ol
MW 139.92
C6H6BFO2
4-F-benzeneboronic acid
Int 14
N
N
O
O
N
F
O2NC18H15FN4O4
MW 370.335
DNDi-0690
step 1
step 4
step 2
step 3step 5
crude
DNDi-0690
step 6
(slurry)
step 7
(clarification)
2-(4-fluorophenyl)-5-{[(7R)-2-nitro-2H,3H,5H,6H,7H-imidazo[2,1-b][1,3]oxazin-7-yl]methoxy}pyridine
GMP Starting material
GMP Starting material
step 2
step 4
step 5
step 3
GMP Starting material
DNDI-0690
No cytotoxicity. Genotoxicity: negative in both mini-AMES and in vitro Micronucleus test. hERG: IC50 =10.29 and IC20 =0.8 µM (whole cell patch clamp, HEK 293 cells at physiological
temperature, GLP). Off-target activity: no significant activity (>50%) at 10 µM against a wide panel of receptors,
channels, transporters and enzymes. GLP 14-day toxicity study in rat: NOAEL identified at the highest dose of 250 mg/kg in both male
and female, corresponding to an AUC0-24h at steady-state of 698 and 619 h*µg/mL, respectively.
Exposure increase less than dose proportional and limited by solubility Absorption limit in rat at AUC ~80000 h*ng/mL No exposure in dog, but suitable exposure in monkey Low risk for drug-drug interaction: No CYP inhibition of 1A2, 2C19,2C9, 2D6 and 3A4, no CYP induction of 1A2 and 2B6, but equivocal data on 3A4
1
10
100
1000
10000
0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96 102108114120126Co
nce
ntr
atio
n (
ng
/mL)
Time (h)
PO 6.75 mg/kg
PO 13.8 mg/kg
PO 12.5 mg/kg (5 days, bid)
Hamster (G. Syrian) plasma exposure
1
10
100
1000
10000
100000
0 6 12 18 24 30 36 42 48 54 60 66 72 78 84 90 96102108114120126132138144
Co
nce
ntr
atio
n (
ng
/mL)
Time (h)
PO 6.63 mg/kg
PO 13.4 mg/kg
PO 26.3 mg/kg
PO 51.5 mg/kg
PO 6.25 mg/kg (5 days, qd)
1
10
100
1000
10000
0 10 20 30 40 50
Co
nce
ntr
atio
n (
ng
/mL)
Time (h)
1 mg/kg IV
5 mg/kgPO
1
10
100
1000
10000
100000
0 6 12 18 24 30 36 42 48 54 60 66 72 78
Co
nce
ntr
atio
n (
ng
/mL)
Time (h)
IV 1.03 mg/kgPO 4.73 mg/kgPO 44.5 mg/kgPO 255 mg/kgPO 870 mg/kg
Rat (SD) plasma exposure Dog (Beagle) plasma exposure
CLint
(mL/min/kg)microsomes
CLint
(mL/min/kg)hepatocytes
Fraction bound (%)
CLint
(mL/min/kg)microsomes
CLint
(mL/min/kg)hepatocytes
Fraction bound (%)
Monkey (Cynomolgus) plasma exposure
< 8.6 26.7 96.6
Mouse (Balb/C) plasma exposure
1
10
100
1000
0 10 20 30 40 50 60 70
Co
nce
ntr
atio
n (
ng
/mL)
Time (h)
1 mg/kg IV
5 mg/kg PO
20 mg/kgPO
13-27 < 4.0 96.583.3 nd 98.8
69.3 nd 96.3 18,6 4.9 97.5
13.1 20.9 89.8
Human plasma exposure
1
10
100
1000
10000
0
Co
nce
ntr
atio
n (
ng
/mL)
Time (h)
?
SAFETY PROFILE
Potency of DNDI-0690 was assessed against various strains/isolates in intra-macrophageassays.Efficacy was determined in vivo in an acute mouse model where Balb/c were infectedwith L. donovani HU3 or L. infantum ITMAP263, while hamsters were infected withITMAP263 strain in a chronic model. In both models, treatment duration was 5 days,unless specified.
0
10
20
30
40
50
60
70
80
90
100
12.5mg/kg
qd
6.25mg/kg
qd
3.125mg/kg
qd
50mg/kg
qd
25mg/kg
qd
12.5mg/kg
qd
6.25mg/kg
qd
3.125mg/kg
qd
1.56mg/kg
qd
12.5mg/kgqd - 1day
6.25mg/kgqd - 1day
6.25mg/kgqd - 3days
2.08mg/kgqd - 4days
L. infantum L. donovani
Par
asit
e lo
ad r
edu
ctio
n in
live
r (%
)
0
10
20
30
40
50
60
70
80
90
100
Live
r
Sple
en
Bo
ne-
mar
row
Live
r
Sple
en
Bo
ne-
mar
row
Live
r
Sple
en
Bo
ne-
mar
row
Live
r
Sple
en
Bo
ne-
mar
row
Live
r
Sple
en
Bo
ne-
mar
row
Live
r
Sple
en
Bo
ne-
mar
row
12.5 mg/kg bid 12.5 mg/kg qd 6.25 mg/kg bid 6.25 mg/kg bid -10 days
25 mg/kg bid 12.5 mg/kg bid
L. infantum L. donovani
Par
asit
e lo
ad r
edu
ctio
n (
%)
VL reference strains IC50 µM
L. donovani DD8 <0.37
L. donovani HU3 0.03 ±0.00
L. infantum
MHOM/MA/67/ITMAP263
0.10 ±0.07
Clinical isolates
L. donovani BHU1 0.26
L. donovani SUKA001 0.46
L. donovani GR265 < 0.37
CL strains
L. major MHOM/IR/-/173 0.32
L. major
MHOM/SA/85/JISH118
4.56
L. guyanensis
MHOM/GF/1999/LG
0.68
L. mexicana
MNYC/BZ/62/M379
<1.11
L. tropica Anwari 2.7
L. tropica
MHOM/IQ/2007/LT
1.6
L. amazonensis DS Red 2 <1.11
POTENCY AGAINSTLEISHMANIA STRAINS
CHRONIC HAMSTER MODEL
ACUTE MOUSE MODEL
5 days
12.5 mg/kg bid
AUC24 (h*µg/mL)
8.14
(0.10)
Cmax (µg/mL)
0.98
(0.01)
Cave (µg/mL)
0.34
(0.004)
Hamster – infantumand donovani
5 days
12.5 mg/kg qd
AUC24 (h*µg/mL)
75.6
(2.69)
Cmax (µg/mL)
6.9
(0.26)
Cave (µg/mL)
3.02
(0.11)
Mouse- infantum
PK/PD
Due to a short half-life, DNDI-0690 will need a twice a day administration. Predicted range: 2x19 to 2x54 mg/day for a 50 kg human being , based on efficacious free
exposure from hamster and mouse studies respectively and predicted human pharmacokinetics based on data from rat and monkey, and human in vitro as well.
Taken together, these results, emphasized by an encouraging safety margin, lead to the conclusionthat DNDI-0690 has the properties of an oral drug candidate for VL.Interestingly, this nitroimidazole compound showed excellent results in two different in vivocutaneous leishmanial models (see poster C1601).Finally, Mode of Action resolution is under completion.
Following the development of a nanosuspension formulation suitable for rodent and non-rodentspecies, DNDI-0690 is currently going through a regulatory pre-IND package.First In Human (FIH) study in scheduled for Q1 2018.
Supported byAcknowledgments
Dr. Andrew Thompson
3 days
6.25 mg/kg qd
AUC24 (h*µg/mL)
52.1
(1.9)
Cmax (µg/mL)
6.21
(0.23)
Cave (µg/mL)
2.17
(0.08)
Mouse - donovani
Cmin (µg/mL)
0.084
(0.001)
Cmin (µg/mL)
0.1
(0.004)
Cmin (µg/mL)
0.05
(0.002)
(): values corrected with free fraction (protein binding)
Efficacious minimal concentration:84 to 100 ng/mL total = 3 to 10.2 nM free
HUMAN DOSE PREDICTION
