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Definitions

• Autism can be characterized by impairments in social interaction
• Autism is now considered to be a developmental disorder and inheritable, with presently unknown
• twin studies show strong genetic heritability for autism; the concordance for autism is 60-91% in monozygotic twins compared to 0-10% in dizygotic twins, and 0.3% in the general population.
• autism candidate genes functionally linked to autism and could therefore be pursued as a therapeutic target.
• bioinformatics tools can now be used identify autism candidate genes that have been shown to have a greater number of protein-protein interactions with other autism candidate genes, called hub genes. It has been hypothesized that these hub genes can serve as "master switches" that control biological function.
• Low-line animals may be used to study autism in human such as low-line rats, who engage in less social contact time with conspecifics, show lower rates of play induced pro- social ultrasonic vocalizations (USVs), and show an increased proportion of non frequency modulated (i.e., monotonous), compared to non-selectively bred random-line animals.
• USVs pro- social ultrasonic vocalizations
• HD Huntington's disease
• CAG trinucleotide repeat that causes a progressive degeneration of neurons, primarily in the putamen, caudate nucleus, and cerebral cortex.
• HD is characterized by movement abnormalities, cognitive impairments, and emotional disturbances, which eventually culminates in death around 15-20 years after the onset of motor symptoms.
• the HD 51 CAG rat utilizes a human HD mutation containing an allele with 51
• CAG repeats This animal model exhibits progressive neurological, neuropathical, and neurochemical phenotypes that closely resemble the late manifesting and slow progression of HD found in humans, and displays HD-like symptoms, such as cognitive impairments and progressive motor dysfunction, as well as neuropathological characteristics, such as neuronal intranuclear inclusions and enlarged lateral ventricles.
• the HD 51 CAG rat closely resembles the human condition, making it a good candidate to study behavioral, cellular, and molecular markers of the disease.
• a method for treating autism in a patient in need thereof, comprising administering to said patient a pharmaceutically effective amount of a NMDA receptor glycine site partial agonist is provided herein.
• the present invention is directed in part to a method for treating autism by administering a therapeutically effective dose of GLYX-13, as disclosed herein, or derivative thereof, for example, a compound having NMDA receptor glycine site partial agonist activity, e.g., a compound that binds to the glycine site of a NMDA receptor, such as a compound disclosed herein.
• a method for treating autism in a patient in need thereof comprising administering to said patient a pharmaceutically effective amount of a compound that modulates a glycine site on a NMDA receptor.
• methods of treating conditions selected from the group consisting of epilepsy, AIDS, AIDS dementia, multiple system atrophy, progressive supra- nuclear palsy, Friedrich's ataxia, autism (and autism spectrum disorder subtypes), fragile X syndrome, tuberous sclerosis, attention deficit disorder, olivio-ponto-cerebellar atrophy, cerebral palsy, Parkinson's disease, drug-induced optic neuritis, peripheral neuropathy, myelopathy, ischemic retinopathy, glaucoma, cardiac arrest, stroke, ischemia, behavior disorders, impulse control disorders, frontal temporal dementia, schizophrenia and bipolar disorders comprising administering a NMDA receptor partial agonist such as GLYX-13 or a compound disclosed herein, to a patient in need thereof.
• a contemplated compound that is capable of modulating the glycine site of a NMDA receptor is represented by (GLYX-13):
• Also contemplated herein is a method of treating Alzheimer' s disease, or a method of treating memory loss that accompanies early stage Alzheimer's disease in a patient in need thereof, comprising administering to the patient a disclosed compound.
• methods are provided herein of treating attention deficit disorder, ADHD, schizophrenia, anxiety, amelioration or treatment of addiction, e.g., of opiate, nicotine and/or ethanol addiction, traumatic brain injury, post-traumatic stress syndrome and/or Huntington's chorea (i.e., Huntington's disease) in a patient in need thereof, comprising administering to the patient a compound disclosed herein.
• a contemplated compound is administered intravenously, intraperitoneally, intramuscularly, or subcutaneously, for example, a contemplated method may include administering a single-dose of said compound.
• disclosed methods may provide, after about 1 day, or even after 8 days of administration of a disclosed compound, substantial improvement in one or more autism symptoms of a patient.
• disclosed compounds may be administered daily.
• a pharmaceutically effective amount of a disclosed compound may be about O.Olmg/kg to about 1000 mg/kg.
• Also provided herein is a method of treating autism in a patient in need thereof, comprising administering to said patient a single dose of a compound represented by:
• a single dose may include for example, about 0.01 mg/kg to about 1000 mg/kg of a disclosed compound.
• the disclosed invention relates to administering a di- pyrrolidine peptide compound comprising the sequence Thr-Pro-Pro-Thr, or exemplified by Formula A (GLYX-13) for the treatment of autism in mammals including humans.
• FIGURE 1 depicts Mean + SEM (A) time spent in direct social contact in adult male Long Evans rats selectively bred for low or random rates of play-induced pro-social USVs. Animals were tested in pairs with a conspecific of the same selectively bred line. (B)
• Rates of conspecific play induced pro-social USVs (frequency-modulated 50 kHz calls) in adult male low and random- line animals.
• FIGURE 2 depicts Mean + SEM (A) rates of conspecific play induced pro-social
• USVs frequency-modulated 50 kHz calls
• vehicle 1 mg/ml sterile saline s.c.
• GLYX-13 50 mg/kg s.c. 15 min before the start of testing using a within- subjects design.
• FIGURE 3 depicts significantly changes in genes in two brain regions (medial prefrontal cortex and nucleus accumbens) of low line animals compared to non- selectively bred random- line animals.
• FIGURE 4 depicts delayed neuronal death produced by ⁇ ( 1-42) in
• FIGURE 5 depicts rescue of ⁇ impairment of long-term potentiation (LTP) of synaptic transmission at Schaffer collateral-CAl synapses in hippocampal slices in presence of GLYX-13.
• B Time course of the effect of pressure ejection of ⁇ (1- 42) into stratum radiatum of field CA1 in the presence of ⁇ Glyx-13 ( ⁇ injections;
• FIGURE 6 indicates the results repeated-measures analysis of variance and a series of one-way ANOVAs between WT and HD rats administered GLYX-13.
• Figure 6b indicates d no significant differences between WT and HD rats in the "Correct” Rate of lever presses, measured in the amount of lever presses per second, during Phase Three Pseudo- Random testing.
• GLYX peptide refers to a peptide having NMDAR glycine-site partial agonist/antagonist activity. GLYX peptides may be obtained by well-known recombinant or synthetic methods such as those described in US Patents 5,763,393 and 4,086,196 herein incorporated by reference. In some embodiments, GLYX refers to a tetrapeptide having the amino acid sequence Thr-Pro-Pro-Thr (SEQ ID NO: 1), or L-threonyl- L-prolyl-L-prolyl-L-threonine amide.
• GLYX-13 refers to the compound depicted as:
• GLYX 13 polymorphs, hydrates, homologs, solvates, free bases, and/or suitable salt forms of GLYX 13 such as, but not limited to, the acetate salt.
• the peptide may be cyclyzed or non-cyclyzed form as further described in US 5,763,393.
• an GLYX-13 analog may include an insertion or deletion of a moiety on one or more of the Thr or Pro groups such as a deletion of CH 2 , OH, or NH 2 moiety.
• GLYX-13 may be optionally substituted with one or more halogens, CrC 3 alkyl (optionally substituted with halogen or amino), hydroxyl, and/or amino.
• peptides disclosed here can include both natural and unnatural amino acids, e.g., all natural amino acids (or derivatives thereof), all unnatural amino acids (or derivatives thereof), or a mixture of natural and unnatural amino acids.
• one, two, three or more of the amino acids in GLYX-13 may each have,
• compounds for use in one or more disclosed methods include those of Formula I:
• T is, independently for each occurrence, CR 4 R 4 , and n is 0, 1, 2 or 3;
• A is optionally present and is selected from phenyl or pyridine, wherein A is optionally substituted by one or more substituents selected from R a ;
• Ri is selected from the group consisting of H, hydroxyl, -S(0) 2 -Ci- 4 alkyl; -SO 2 , Q- 4alkyl, C 2 -C 4 alkenyl, phenyl, R 7 , or , wherein Ci- 4 alkyl, C 2 - 4 alkenyl, or phenyl is optionally substituted by one or more substituents selected from R a ;
• X is CH or N
• R 3 and R 3 are independently selected from the group consisting of H, halogen, hydroxyl, phenyl, Ci- 4 alkyl, amido, amine, or C 2 - 4 alkenyl, wherein Ci- 4 alkyl, C 2 - 4alkenyl and phenyl are optionally substituted by one or more substituents selected from
• R4 and R 4 are independently selected from the group consisting of H, halogen, hydroxyl, phenyl, Ci- 4 alkyl, amido, amine, Ci- 4 alkoxy or C 2 - 4 alkenyl, wherein Q- 4alkyl, C 2 - 4 alkenyl, Ci- 4 alkoxy, and phenyl are optionally substituted by one or more substituents selected from R a ;
• R 2 is selected from the group consisting of H, R 7 , -S(0) 2 , S(0) 2 -C 1 -C 4 alkyl, Q ⁇ alkyl, hydroxyl, or phenyl wherein Q ⁇ alkyl, C 2 _ 4 alkenyl and phenyl are optionally substituted by one or more substituents selected from R a ;
• R5 and R5' are each independently selected from group consisting of H, halogen, Q- 4 alkyl, C 1 - 4 alkoxy, C 2 - 4 alkenyl, cyano, amino, phenyl, and hydroxyl, wherein C 1 - 4 alkyl, C 2 - 4 alkenyl and phenyl are optionally substituted by one or more substituents selected from R a ;
• R 7 is selected from group consisting of -C(0)-Rg, -C(0)-0-Rg, or -C(0)-NR d -R9,
• R9 is selected from the group consisting of H, C 1 - 4 alkyl, phenyl, or heterocyclic, wherein C 1 - 4 alkyl, phenyl or heterocyclic is optionally substituted by 1, 2 or 3 substituents selected from R
• R 8 is selected from group consisting of H, -C(O)- C 1 - 4 alkyl or C(0)-0- Q- 4 alkyl, wherein C 1 - 4 alkyl is optionally substituted by 1, 2 or 3 substituents selected from R a ;
• R a is selected, independently for each occurrence, from carboxy, hydroxyl, halogen, amino, phenyl, C ⁇ alkyl, and C 1 - 4 alkoxy;
• R b is selected, independently for each occurrence, from the group consisting of carboxy, hydroxyl, halogen, amino, phenyl, C ⁇ alkyl, C 1 - 4 alkoxy, and -NH-R C ;
• R c is selected, independently for each occurrence from the group consisting of: -C(O)- 0-Ci- 4 alkyl; and -C(0)-Ci- 4 alkyl; and
• R d is selected, independently for each occurrence, H and C ⁇ alkyl
• contemplated compounds include:
• Contemplated methods include a method of treating autism and/or an autism spectrum disorder in a patient need thereof, comprising administering an effective amount of a disclosed compound (e.g. a compound described above) to the patient.
• a method for reducing the symptoms of autism in a patient in need thereof is contemplated, comprising administering an effective amount of a disclosed compound to the patient.
• the compound may decrease the incidence of one or more symptoms of autism such as eye contact avoidance, failure to socialize, attention deficit, poor mood, hyperactivity, abnormal sound sensitivity, inappropriate speech, disrupted sleep, and perseveration. Such decreased incidence may be measured relative to the incidence in the untreated individual or an untreated individual(s).
• patients suffering from autism also suffer from another medical condition, such as Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, and untreated phenylketonuria.
• methods of treating a disorder in a patient need thereof are contemplated, wherein the disorder is selected from group consisting of: epilepsy, AIDS and/or AIDS dementia, Parkinson's disease, multiple system atrophy, progressive supra-nuclear palsy, Friedrich's ataxia, autism, fragile X syndrome, tuberous sclerosis, attention deficit disorder, olivio-ponto-cerebellar atrophy, cerebral palsy, drug-induced optic neuritis, peripheral neuropathy, myelopathy, ischemic retinopathy, glaucoma, cardiac arrest, behavior disorders, and impulse control disorders that includes administering a disclosed compound, e.g GLYX-13.
• a method for treating cough e.g. uncontrollable cough, comprising
• a disclosed compound for example, provided here are methods of treating benign Rolanic epilepsy, frontal lobe epilepsy, infantile spasms, juveline myoclonic epilepsy, Lennox-Gastaut syndrome, Landau-Kleffner syndrome, Dravet syndrome, progressive myoclonus epilepsies, reflex epilepsy, Rasmussen's syndrome, temporal lobe epilepsy, limbic epilepsy, status epilepticus, abdominal epilepsy, massive bilateral myoclonus, catamenial epilepsy, Jacksonian seizure disorder, Lafora disease, and /or photosensitive epilepsy comprising administering an effective amount of a disclosed compound.
• contemplated herein are methods of treating attention deficit disorder, ADHD (attention deficit hyperactivity disorder), schizophrenia (for example, schizoaffective disorders, delusional disorders, e.g., paranoid type, hebephrenic, and/or catatonic type schizophrenia), bipolar disorder (include bipolar I disorder, bipolar II disorder, cyclothymia), borderline personality disorder, anxiety, (include social anxiety disorder, avoidant personality disorder), obsessive-compulsive disorder, amelioration of opiate, nicotine and/or ethanol addiction (e.g., method of treating such addiction or ameliorating the side effects of
• a disclosed compound e.g., GLYX-13.
• patients suffering from schizophrenia, addiction (e.g. ethanol or opiate), autism (and autism spectrum disorders), Huntington's chorea, traumatic brain injury, spinal cord injury, post-traumatic stress syndrome and diabetic retinopathy may all be suffering from altered NMDA receptor expression or functions.
• a method of treating schizophrenia for example, the negative and cognitive symptoms of schizophrenia in a patient suffering therefrom, comprising administering a therapeutically effective amount of a disclosed compound.
• Contemplated here is a method of treating stroke and/or ischemia, e.g., ischemic stroke, brain ischemia, transient ischemic attack, cardiac ischemia,and/or myocardial infarction, in a patient in need thereof, comprising administering a pharmaceutically effective amount of GLYX-13.
• stroke and/or ischemia e.g., ischemic stroke, brain ischemia, transient ischemic attack, cardiac ischemia,and/or myocardial infarction
• Also provided herein is a method of modulating an autism target gene expression in a cell comprising contacting a cell with an effective amount of a disclosed compound, e.g GLYX-13.
• the autism gene expression may be for example, selected from ABAT, APOE, CHRNA4, GABRA5,GFAP, GRIN2A, PDYN, and PENK.
• a method of modulating synaptic plasticity in a patient suffering from a synaptic plasticity related disorder comprising administering to the patient an effective amount of a disclosed compound, such as GLYX-13, or pharmaceutically acceptable salts thereof.
• a method of treating Alzheimer's disease, or e.g., treatment of memory loss that e.g., accompanies early stage Alzheimer's disease, in a patient in need thereof comprising administering a disclosed compound, e.g., GLYX-13.
• a method of modulating an Alzheimer's amyloid protein e.g., beta amyloid peptide, e.g. the isoform ⁇
• in-vitro or in-vivo e.g. in a cell
• GLYX-13 or another disclosed compound may block the ability of such amyloid protein to inhibit long-term potentiation in hippocampal slices as well as apoptotic neuronal cell death.
• a disclosed compound e.g., GLYX- 13
• GLYX- 13 may provide neuroprotective properties to a Alzheimer's patient in need thereof, for example, may provide a therapeutic effect on later stage Alzheimer's -associated neuronal cell death.
• the patient is a human, e.g. a human pediatric patient.
• contemplated methods relate to use of a disclosed compound or compounds alone or in combination with one or more other agents for
• a contemplated compound e.g., GLYX-13, or a composition comprising a contemplated compound and, e.g., a pharmaceutically acceptable excipient
• a contemplated compound may be administered parenterally to a patient including, but not limited to, subcutaneously and intravenously.
• the compound or compositions of the invention may also be administered via slow controlled i.v. infusion or by release from an implant device.
• a disclosed method for treating autism includes administering one dose, or one or more doses, of a disclosed compound.
• a patient has substantial improvement in autism symptoms after 12 hours, after 1 day, after 1 week, after 2 days, after 3 days, after 4 days, after 5 days, after 6 days, or even after 8 days of a one (single) dose administration.
• a therapeutically effective amount of a disclosed compound required for use in therapy varies with the nature of the autism condition being treated, the length of treatment time desired, the age and the condition of the patient, and is ultimately determined by the attending physician.
• doses employed for adult human treatment typically are in the range of about 0.01 mg/kg to about 1000 mg/kg per day.
• the dose may be about 1 mg/kg to about 100 mg/kg per day.
• the desired dose may be conveniently administered in a single dose, or as multiple doses administered at appropriate intervals, for example as two, three, four or more sub-doses per day.
• the dosage of the compounds of the present invention may be given at relatively lower dosages.
• the dosage of a compound of the present invention may be from about 1 ng/kg to about 100 mg/kg.
• the dosage of a compound of the present invention may be at any dosage including, but not limited to, about 1 ug/kg, 25 ug/kg, 50 ug/kg, 75 ug/kg, 100 u ug/kg, 125 ug/kg, 150 ug/kg, 175 ug/kg, 200 ug/kg, 225 ug/kg, 250 ug/kg, 275 ug/kg, 300 ug/kg, 325 ug/kg, 350 ug/kg, 375 ug/kg, 400 ug/kg, 425 ug/kg, 450 ug/kg, 475 ug/kg, 500 ug/kg, 525 ug/kg, 550 ug/kg, 575 ug/kg, 600 ug/kg, 625 ug/kg, 650 ug/kg, 675 ug/kg, 700 ug/kg, 725 ug/kg, 750
• Disclosed compounds may be provided as part of a liquid or solid formulation, for example, aqueous or oily suspensions, solutions, emulsions, syrups, and/or elixirs.
• the compositions may also be formulated as a dry product for constitution with water or other suitable vehicle before use.
• Such liquid preparations may contain additives including, but not limited to, suspending agents, emulsifying agents, nonaqueous vehicles and preservatives.
• Suspending agent include, but are not limited to, sorbitol syrup, methyl cellulose,
• Emulsifying agents include, but are not limited to, lecithin, sorbitan monooleate, and acacia.
• Nonaqueous vehicles include, but are not limited to, edible oils, almond oil, fractionated coconut oil, oily esters, propylene glycol, and ethyl alcohol.
• Preservatives include, but are not limited to, methyl or propyl hydroxybenzoate and sorbic acid.
• Contemplated compounds may also be formulated for parenteral administration including, but not limited to, by injection or continuous infusion.
• Formulations for injection may be in the form of suspensions, solutions, or emulsions in oily or aqueous vehicles, and may contain formulation agents including, but not limited to, suspending, stabilizing, and dispersing agents.
• the composition may also be provided in a powder form for reconstitution with a suitable vehicle including, but not limited to, sterile, pyrogen-free water.
• FIGURE 1A depicts the Mean + SEM time these rats spent in direct social contact.
• FIGURE IB illustrates the rates of conspecific play induced pro-social USVs (frequency-modulated 50 kHz calls) in adult male low and random-line animals.
• FIGURE 1C illustrates the proportion of total conspecific play induced USVs that are monotonous (i.e., bandwidth less than 7 kHz).
• FIGURE 2B shows the results of treatment with GLYX-13 (50 mg/kg s.c.) 15 min before the start of testing using a within- subjects design.
• the proportion of total conspecific play induced USVs that were monotonous i.e., bandwidth less than 7 kHz is shown in FIGURE 2C.
• n 9 per group. * P ⁇ .05 Fisher PLSD post hoc test, 2 tailed.
• GLYX-13 significantly increased rates of play inducing pro-social USVs and significantly decreased the proportion of total USVs that are monotonous.
• the NMDA receptor was identified as a hub in the genes differentially expressed in the low-line animals [Mean + SEM (0.985 + 0.004) average connections per gene differentially expressed in low-line animals compared to 3 connections for the NR2A subunit of the NMDA receptor; P ⁇ .0001 one tailed t-test].
• the cortical microarray data from rats that received social defeat which is not thought to model autism was also analyzed, and found that neither the autism candidate genes were upregulated in this gene set, nor was the NMDAR identified as a hub gene (all P's > .05).
• HD 51 CAG and WT (wild type) rats are used in a Huntington's disease model study, testing cognition with serial operant reversal tasks. Rats are dosed according to the following schedule:
• the animals are first placed in an acquisition trial.
• the acquisition trial is an 8- hour testing period where the animal is reinforced with a sucrose food pellet for a "correct" lever press after a variable interval time of 30 seconds. This task requires the animals to learn which lever needs to be activated to gain reinforcement. The time taken to identify the
• the animals are trained on a progressive fixed ratio (FR) schedule of reinforcement, using increments of one lever presses until they are pressing the lever 15 times to receive a reinforce (i.e., an FR15), which typically takes three days.
• a reinforce i.e., an FR15
• the operant program will be running for a maximum of 60 minutes or until the rat achieves a maximum of 200 sucrose pellets, upon which time they will be immediately removed from the chambers and placed back into their home cage.
• the MED PC IV program is used to increase the FR in small increments depending on the performance of the rat (i.e. the rat will have the FR increased to FR2 after achieving 15 reinforcers on FR1.
• the rats are put into the chambers for two consecutive days of training on FR16 help establish a baseline response rate and to allow the animal to become accustomed to multiple lever presses to gain reinforcement.
• the testing session is conducted using a progressive FR schedule for 25 or 30 days.
• the first phase of testing consists of nine days of FR, with the left lever being the "correct" lever for reinforcement.
• the rats start on a FR2 and then move to the next increased FR each day, until they reach FR512 (2, 4, 8, 16, 32, 64, 128, 256, and 512, respectively).
• the response rate for the left and right lever is recorded, as well as the total number of lever presses for each side, the total number of lever presses combined for each side in a session, the percentage of "correct” lever presses ("correct” lever presses/left lever presses + right lever presses then multiplied by 100 to obtain a percentage), the total reinforcers earned, and the time to complete each session.
• the rats are given one day off before the second phase of testing begins, with only the weight of the rats being recorded.
• phase I both the HD and WT animals press the correct lever in proportion to total presses.
• the second phase of testing consists of nine days of FR testing, with the right lever now becoming the "correct" lever for reinforcement.
• the second phase of testing is identical to the first phase, with the exception of the spatial reversal of the "correct” lever. The same measures are recorded.
• phase II the correct response lever is switched to the right side. Both HD and WT animals press the correct lever similarly in proportion to total presses. However, the HD animals show preservative errors with increased incorrect lever presses on day 2.
• the rats are given a day off, with only their weights being recorded and enter a pseudo-random mixed schedule.
• the pseudo-random phase consists of rats performing a FR32 (when the animals are responding at the highest response rate) for six days with the "correct" being switched pseudo-randomly (e.g., Left, Left, Right, Right, Left, and Right).
• GLYX-13 was delivered subcutaneously 20 minutes prior to start of task, using dosage schedule above. Both WT and HD animals administered GLYX-13 show higher percentage trends of correct lever presses than animals with saline injections. See Figure 6.
• Figure 6A indicates repeated-measures analysis of variance and a series of oneway ANOVAs revealed no significant differences between WT and HD rats in the "Correct" Rate of lever presses, measured in the amount of lever presses per second, during Phase Three Pseudo-Random testing.
• the rats are placed into the open field motor monitor system (Kinder Scientific; Poway, CA). The rats are then tested during their nocturnal phase for one hour, and the total distance traveled, basic and fine movements performed, the proximity to the center, and the number of rears (i.e., standing on hind legs) is recorded. Total distance traveled indicates if the HD 51 CAG rats exhibit any hyper- or hypoactivity, relative to the wild- type rats. Total number of rearing events is an additional measure of exploratory behavior and activity levels, but can also help detect motor abnormalities. EQUIVALENTS

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