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Definitions

• NARP Neurodeficiency in ATP production via the oxidative phosphorylation pathway
• NARP syndrome mitochondrial pathologies involving a deficiency in ATP production via the oxidative phosphorylation pathway, such as NARP syndrome.
• NARP Neuroopathy, Ataxia and Retinitis Pigmentosa
• RP retinitis pigmentosa
• dementia dementia
• ataxia proximal neurological muscle weakness and sensory neuropathies
• This disease is in general a pathology which occurs in children, but it has also been reported in rarer cases in adults.
• the clinical manifestations are varied and can take more or less severe forms.
• the ophthalmic manifestations can range from a simple "salt and pepper” changing of the retina to severe RP, accompanied by maculopathy.
• there is a broad spectrum of neurological manifestations which ranges from simple migraines to severe dementia and to "Leigh's disease” (subacute necrotising encephalomyelopathy; Ortiz et al, Arch., Ophtalmol., 1993, 111, 1525-1530).
• retinitis pigmentosa- related syndromes exist, such as Usher's syndrome in which both the sight and the hearing are affected, or else macular dystrophy, also called inverse RP.
• Holt et al. Am. J. Hum. Genet., 46, 428-433
• Tatuch and Robinson Biochem. Biophys. Res. Commun., 1993, 192, 124-128 that this mutation -occurring in the ATP6 subunit- resulted in a reduction in ATP synthesis by impairing the mitochondrial ATP synthase complex.
• This mutation is thought to be responsible for an ATP synthase assembly/stability defect (Nijtmans et al, J. Biol. Chem., 2001, 276, 6755-6762).
• Other ATP6 gene mutations have also been detected, in association with NARP syndrome/Leigh's disease; T8993C, T9176G, T9176C, T8851C, T9185C and T9191C (Schon et al, Cell & Dev. Biol., 2001, 12, 441-448 and Kucharczyk et al, Biochimica et Biophysica Acta, 2009, 1793, 186-199).
• a T9101C mutation has been involved in the LHON ⁇ Leber's Hereditary Optic Neuropathy) syndrome, another mitochondrial syndrome (Kucharczyk et al, Biochimica et Biophysica Acta, 2009, 1793, 186-199). Simple point mutations are therefore responsible for these syndromes, which have many more or less serious forms.
• the great diversity of the pathological manifestations is attributed to the heteroplasmic nature of this mutation in patients, i.e. the coexistence of mutated and wild-type mitochondrial DNA molecules in the cells or tissues.
• the mutated mitochondrial DNA load is closely correlated with the seriousness of the symptoms observed (Uziel et al, J. Neurol. Neurosurg. Psychiatry, 1997, 63, 16-22; Carelli et al, Arch. Neurol., 2002, 59, 264-270).
• the ATP synthase complex which is the target of the T8993G mutation (and of the other mutations mentioned above), is located in the inner mitochondrial membrane ( Figures 1 and 2A). It catalyzes the last steps of oxidative phosphorylation, a process which allows cells to extract the chemical energy of metabolites and to store this energy in ATP molecules.
• the ATP synthase complex uses the electrochemical proton gradient on either side of the inner membrane, generated by other complexes located in this membrane, the respiratory complexes ( Figure 1). The latter transfer to oxygen the reducing equivalents of the substrates that are oxidized in the mitochondrion.
• ATP synthase operates like a rotary turbine: the passage of protons in F 0 is coupled to the rotation of a subcomplex (the rotor) of the enzyme. This rotation results in conformational changes in Fi which promote the synthesis of ATP from ADP and inorganic phosphate (Boyer P. D., Annu, Rev., Biochem., 1997, 66, 717-747).
• the neosynthesized ATP molecules can, via a specific transporter located in the inner membrane (ADP/ ATP translocase), leave the mitochondrial compartment so as to supply the entire cell with energy.
• ATP synthase comprises about twenty different protein subunits for a mass of approximately 600 KDa.
• Atp6p and Atp ⁇ p Two ATP synthase subunits (Atp6p and Atp ⁇ p, Figure 2A) are encoded by the mitochondrial genome, all the other subunits being encoded by nuclear genes.
• the subunits of nuclear origin are synthesized in the cytosol and then imported into the mitochondrion, whereas the Atp6p and Atp ⁇ p subunits encoded by the mitochondrial genome are actually synthesized inside the mitochondrion ( Figure 2A).
• the T8993G mutation associated with NARP syndrome is located within the mitochondrial ATP 6 gene ( Figure 2B).
• the latter encodes ATP synthase subunit 6 (Atp ⁇ p) which is essential for proton transport across F 0 .
• the T8993G mutation results in the replacement, with arginine, of a leucine residue conserved in all the known sequences of Atp ⁇ p, from bacteria to humans. This leucine residue is in an Atp ⁇ p region presumed to be transmembrane and essential for ATP synthase proton translocation activity.
• a cellular model for the NARP syndrome has recently been developed consisting in yeast strains carrying within their mitochondrial genome, the equivalent of mitochondrial ATP6 gene mutations responsible for NARP syndrome in humans (see the International PCT Application WO 2007/125225). These yeast mutants make it possible to identify molecules capable of correcting the effects of the mutation by restoring either ATP synthase function, or sufficient production of ATP in the mitochondria, via a pathway other than that of oxidative phosphorylation.
• the invention concerns compounds which have been selected for their ability to restore respiratory growth of the yeast ATP 6 mutant ( Figures 3 A and 3B).
• An object of the present invention concerns the use of compounds having the general formula (I):
• X is a carbon atom or a nitrogen atom, both atoms being optionally - A - substituted by an oxygen atom;
• R 1 is a hydrogen atom, a halogen atom or a sulphur atom
• R 2 is a hydrogen atom or
• R 1 and R 2 taken together with the carbon atoms to which they are attached may form the following cycle
• R 3 is a hydrogen atom; a halogen atom; an alkyl radical containing 1 to 6 carbon atoms, preferably 1 to 3 carbon atoms, optionally interrupted by one oxygen atom or one ester function or an alkenylene radical containing 2 to 6 carbon atoms, preferably 2 to 3 carbon atoms, with the proviso that when R 1 and R 2 do not correspond to the above defined cycle, R 3 is a hydrogen atom; - R 4 is: a hydrogen atom, an alkyl radical containing 1 to 6 carbon atoms, preferably 1 to 3 carbon atoms, optionally interrupted by one oxygen atom, a linear chain containing between 5 and 15 carbon atoms and between 1 and 10 nitrogen atoms, said chain optionally contains 1 to 5 oxygen atoms and is optionally interrupted by a benzyl group optionally substituted by one halogen atom; carbon and/or nitrogen atoms of said chain being optionally substituted by 1 or 2 alkyl radicals containing 1 to 3 carbon atoms,
• R 5 is a hydrogen atom, a halogen atom, or a group ;
• R 4 and R 5 taken together with the carbon atoms to which they are attached may form the following cycle 0"" ⁇ ;
• R 6 , R 7 and R 8 which may be identical or different, are: a hydrogen atom; a halogen atom; - an alkyl radical containing 1 to 6 carbon atoms, preferably 1 to
• R 6 Cl
• R 3 is not -0-CH 3 or when R 1 and R 2 correspond to the above defined cycle
• R 7 is in ortho-position of R 6 , R 6 and R 7 are not simultaneously -0-CH 3 , or a pharmaceutical acceptable salt for the preparation of a drug for the prevention and/or the treatment of disorders or diseases related to an insufficiency or a lack of ATP synthesis by FiF 0 -ATP synthase or related to an excessive accumulation of reactive oxygen species (ROS) chosen amongst mitochondrial diseases, normal or physiological ageing and neurodegenerative diseases.
• ROS reactive oxygen species
• halogen atom is intended to mean fluorine, chlorine, bromine or iodine.
• alkyl radical containing 1 to 6 carbon atoms, is intended to mean a saturated, linear or branched, chain of 1 to 6 carbon atoms, such as methyl, ethyl, propyl, isopropyl, butyl, pentyl, hexyl...
• alkenylene radical containing 2 to 6 carbon atoms is intended to mean an unsaturated, linear or branched, chain of 2 to 6 carbon atoms containing one carbon-to-carbon double bond.
• alkyl radicals containing 1 to 6 carbon atoms interrupted by one oxygen atom are of the general formula -(CH 2 ) n -O-(CH 2 ) n -CH 3 , n and n' being two integers comprised between 0 and 6 such as n + n' ⁇ 6; an example of such radical is -0-CH 3 .
• alkyl radicals containing 1 to 6 carbon atoms preferably
• 1 to 3 carbon atoms, optionally interrupted by one oxygen atom or one ester function and optionally containing a benzyl group are: -0-CH 3 , -0-CH 2 -C 6 H 6 , -CO-O-CH 3 , and -CO-O-CH 2 -C 6 H 6 ...
• Chlorhexidine is known to have antiseptic properties, it shows also bactericidal properties, it kills both gram-positive and gram-negative bacteria.
• Benzethonium chloride is a synthetic quaternary ammonium salt with surfactant, antiseptic and anti infective properties.
• Sodium pyrithione (CAS Registry number: 15922-78-8 ; 3811-73-2) is a large spectrum antimicrobial agent; it inhibits the growth of fungi, yeast, mold and bacteria.
• compounds of formula (I) are such as R 1 and R 2 form the above-defined cycle; the preferred compounds are those defined by the general formula (Ia):
• R 3 , R 5 , R 6 , R 7 and R 8 are defined as above; - R 4 is:
• alkyl radical containing 1 to 6 carbon atoms, preferably 1 to 3 carbon atoms, optionally interrupted by one oxygen atom;
• the invention relates to compounds of general formula (Ia) as drug, particularly, as active agents.
• the hitherto unknown compounds 8, 10, 31, 32, 33, 34, 35 and 36 may be prepared, starting from the appropriate salicylaldehydes and (Z) b-chloro-b- nitrostyrenes, according to the methodology reported in the article of D. DAUZONNE et P. DEMERSEMAN ⁇ Synthesis, 66-70 (1990)).
• preferred compounds of general formula (Ia) are compounds 5, 6, 7, 8, 9, 10, 1 1, 12, 13, 14, 15, 18, 20, 21, 22, 23, 24, 25, 27, 32 and 36.
• More preferred compounds of general formula (Ia) are compounds 5, 6, 7, 8, 10, 1 1, 13, 15, 18, 21, 22, 23, 32 and 36.
• compounds of general formula (I) are useful for the preparation of a drug for preventing and/or treating mitochondrial diseases, in particular for the treatment of mammals, such as human.
• mitochondrial diseases often result from a deficiency in ATP production -via the oxidative phosphorylation- which makes high energy-demanding tissues or organs such as heart, brain, and muscles, the main targets for these disorders.
• ROS reactive oxygen species
• Symptoms of mitochondrial diseases usually include slow growth, loss of muscle coordination, muscle weakness, visual defect, hearing defects, learning disabilities, mental retardation, heart disease, liver disease, kidney disease, gastrointestinal disorders, respiratory disorders, neurological problems, and dementia.
• Compounds of general formula (I) appear to be also useful for the preparation of a drug for preventing and/or treating an acceleration of normal or physiological ageing.
• Physiological ageing is characterized by numerous phenomena; it may be characterized by the decrease of cells renewal; by the decrease of cells life and/or by the decrease of the number of cells in an organ, leading to atrophy and sometimes to dysfunction of said organ.
• Other evidences of ageing are modification of the appearance such as loss and/or graying of the hair, modification of appearance of the skin...
• the present invention also relates to the use of compounds of general formula (I) for preventing and/or treating neurodegenerative diseases such as Alzheimer's disease, myasteny disease, Parkinson's disease...
• the present invention relates to the use of compound of Formula C (Clotrimazole)
• a drug for preventing and/or treating the symptoms of the mitochondrial diseases chosen in the group consisting of slow growth, muscle weakness, visual defect, hearing defect, heart disease, liver disease, kidney disease, gastrointestinal disorders and respiratory disorders, in particular for the treatment of mammals, such as human.
• Clotrimazole is an antifungal agent.
• clotrimazole may be prepared according to South African Patents 68 05,392 and 69 00,039 (Bayer).
• Figure 1 is a schematic representation of the mitochondrial energy transduction apparatus and of the genes controlling the formation thereof.
• FIGS 2A and 2B illustrate the structure of the ATP synthase and the genes encoding this protein complex: the ATP synthase is composed of subunits which are encoded by the nuclear DNA and by the mitochondrial DNA (Atp ⁇ p,
• FIG. 2B focuses on the mitochondrial DNA and the mutations which are associated with human mitochondrial disease (from mitomap.org).
• Figures 3A and 3B are pictures of Petri dishes showing the ability of compounds of general formula (I) to restore respiratory growth of the ATP synthase 5 yeast mutant on nonfermentable medium.
• the three upper panels of figure 3A show that the ATP synthase mutants strains (three NARP strains and the fine IA) grow very slowly on a respiratory medium (nonfermentable carbon source) due to a defect of the ATP synthase (Example 1).
• the three lower panels of Figure 3A illustrate the improvement of0 the respiratory growth when compounds (Chlorhexidine, Benzethonium Chloride or Clotrimazole instead of DMSO, the negative control) are added into the agar medium at different concentrations.
• compounds Chlorhexidine, Benzethonium Chloride or Clotrimazole instead of DMSO, the negative control
• the mutant cells are plated out in a layer at the surface of an agar medium containing nonfermentable carbon source and compounds are5 added on filters and disposed on Petri dish.
• the negative control, DMSO and the positive control, oleate, are loadded on the upper left filter and on the lower right filter respectively.
• Figures 4 to 8 are graphs showing the effect of compounds of general formula (I) on life expectancy of Drosophila having mitochondrial O encephalomyopathy (Example 2).
• Figure 9 is a graph showing the effect of compound of Formula A (chlorhexidine, CH) on growth of a NARP mammalian model (Example 3).
• Example 1 Demonstration of the capacity of compounds of general formula (I) to restore respiratory growth of mutant yeasts on5 nonfermentable medium
• the ATP 6 yeast mutants grow very slowly from a nonfermentable carbon source due to a dysfunction of the ATP synthase. These yeast mutants are therefore used to identify molecules capable of correcting the effects of the mutation by restoring either ATP synthase function, or ATP production by the mitochondria O allowing the yeasts to grow on nonfermentable medium.
• Genotype MC6: Mat a, ade2, Ieu2, ura3, trpl, his3,fmcl::HIS3 • MR 14 (NARP T8993G) which may be obtained according to International PCT Application WO 2007/125225.
• Genotype MR14: Mat a, ade2, Ieu2, ura3, trp], his3, arg8::HIS3[rho + FY1679; atp ⁇ T8993G]
• the principle of the activity test is the following:
• Step 1 the mutant yeast is cultured in medium containing glucose (YPAD medium).
• Step 2 the mutant cells are plated out in a layer at the surface of an agar medium containing a nonfermentable carbon source such as glycerol (YPG medium).
• a nonfermentable carbon source such as glycerol (YPG medium).
• Step 3 filters which each contain a defined amount of one of the test molecules are placed on the Petri dish, the molecules diffuse in the medium and establish a concentration gradient around the filters.
• Step 4 the dishes are incubated at 35 or 36°C. Under these conditions, a growth halo is seen to appear around the filters containing a substance capable of counteracting the effects of the mutation.
• YPG medium contains 1% Yeast Extract; 2% Bactopeptone; 2% Bactoagar only for solid medium; 2% glycerol (expressed in weight/volume); Adenine 60mg/lL and spenicilline 30 000UI/L.
• Liquid YPAD medium contains 1% Yeast Extract; 2% Bactopeptone; 2% glucose (expressed in weight/volume) and Adenine 60mg/L.
• the optical density (OD) of the culture is measured; the culture is diluted in liquid YPAD medium (50 or 100 ⁇ l in 4ml of medium if the broth is saturated). After 4-5 h, OD of the culture is measured; the culture is diluted in
• 240 ⁇ l of the culture is introduced in squared dishes (12cm /12cm) and plated with sterile glass beads.
• the dishes are incubated at 35°C for MRl 4 yeast strain or 36°C for MC6 yeast strain. Results
• Activity of the compounds is detected when mutant yeasts grow around the filters forming a growth halo; the size and the density of said halo allow defining a qualitative value for activity. All the selected drugs are active on both mutant strains (MRl 4 and fine IA).
• Example 2 Demonstration of the capacity of compounds of general formula (I) to improve lifespan of Drosophila suffering from mitochondrial encephalomvopathv Compounds of general formula (I) have then been tested on a
• Drosophila model described by Celotto et al. (Mitochondrial Encephalomyopathy in Drosophila, The Journal of Neuroscience, January 18, 2006 - 26(3):810-820). These Drosophila mutants are known to show a shorter lifespan.
• Each drug was dissolved in 0.09% DMSO to the following final concentrations: 15 ⁇ M, 1 ⁇ M, 50 nM and 2.5 nM.
• Newly eclosed females were counted and placed into a vial with approximately 10 milliliters standard cornmeal molasses media. Test compounds were applied (25 microliters at the specified concentrations) to a semi-circle of filter paper covering about 1/2 of the surface of the media. Longevity experiments were performed using 12:12 light dark regime at 25 C.
• Example 3 Demonstration of the capacity of compound of Formula A (chlorhexidine) to improve the growth of a NARP mammalian model in medium deprivated of glucose After the isolation of active drugs on the NARP yeast models, compounds' activity has been validated on mammalian models for the considered diseases.
• the transmitochondrial cybrids a cell line which is obtained by fusion of NARP patient's platelets containing heteroplasmic level of the mtDNA mutation with human osteosarcoma cells devoided of mtDNA.
• cybrids are using mainly a glycolytic metabolism. Therefore, in glucose medium, glycolysis provides the majority of the cellular ATP and both WT and NARP cybrids (JCP213 and JCP239 lines) present the same growth curves.
• the cells are forced to use a more oxidative metabolism (dependent on mitochondrial ATP production) (Weber, BioChem 2002).
• JICP239 The ability of JICP239 to grow in medium deprivated of glucose has been tested and used as a readout of the ability of the drugs selected in Example 1 to suppress NARP phenotype in human.
• the cybrid lines JCP213 and JCP239 were generated by fusion of the human osteosarcoma cell line 143BK-p° with platelets from wild-type patients or patients with T8993G mutation (Manfredi, G. et al. (1999). J Biol Chem 274, 9386- 9391).
• JCP213 contain 100% of WT mtDNA and JCP239 contain 84 ⁇ 4% of mtDNA with T8993G transversion and were cultivated in Dulbecco's modified Eagle's medium (DMEM), high glucose (4.5 g.l "1 ) supplemented with 5% fetal bovine serum (FBS Gold, PAA), 1 mM sodium pyruvate, 4 mM glutamine, 200 ⁇ M uridine and 20 U.ml "1 penicillin/streptomycin at 37 °C in the atmosphere of 5% CO 2 .
• DMEM Dulbecco's modified Eagle's medium
• FBS Gold fetal bovine serum
• 1 mM sodium pyruvate 4 mM glutamine
• 200 ⁇ M uridine 200 ⁇ M uridine
• U.ml "1 penicillin/streptomycin at 37 °C in the atmosphere of 5% CO 2 .
• 10 4 cells were plated in a 24 well plates containing DMEM with glucose, as described above except the antibiotics. After 24 h, the growth medium is removed, the cells are washed with PBS and
• DMEM without glucose containing the drug or DMSO is added. For each condition of treatment, four wells were used.
• Chlorhexidine (CH) solution in DMSO was diluted 1,000 times in the medium and used at final concentrations from 12.5 to 80 nM for CH.
• DMSO and dihydrolipoic acid (DHLA) at 200 ⁇ M are respectively used as negative and positive controls.
• the NARP cybrids show a much slower growth than the WT cybrids.
• the above-described conditions of culture were used to test the effect of the drugs on the cell viability/proliferation of the NARP cybrids.
• DMSO served as a negative control. After three days in presence of the drug, cell proliferation was estimated by Neutral Red staining (Aure et al. 2007). Each condition was performed using four wells and each experiment was done at least in triplicate. DMSO served as a negative control.
• the first step to validate this cybrid-based assay was to find a positive control.
• the DHLA previously shown to partially correct the NARP fibroblasts deficiencies (Mattiazzi, M. et al. (2004) Hum MoI Genet 13, 869-879) and also uses in therapy to treat patients affected by mitochondrial neuropathies (DiMauro, S. et al. (2006). Muscle Nerve 34, 265-283) was tested as a positive control on the NARP cybrids growth.
• the number of the NARP cybrids, JCP239 was increased by 2.2 fold in presence of 200 ⁇ M of DHLA.
• the DHLA was used as a positive control.

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