WO2015131113A1 - Treatment of conditions associated with hyperinsulinaemia - Google Patents

Treatment of conditions associated with hyperinsulinaemia Download PDF

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Publication number
WO2015131113A1
WO2015131113A1 PCT/US2015/018118 US2015018118W WO2015131113A1 WO 2015131113 A1 WO2015131113 A1 WO 2015131113A1 US 2015018118 W US2015018118 W US 2015018118W WO 2015131113 A1 WO2015131113 A1 WO 2015131113A1
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WIPO (PCT)
Prior art keywords
alkyl
alkylene
aryl
heteroaryl
heterocycloalkyl
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PCT/US2015/018118
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English (en)
French (fr)
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Steven B. Landau
Michael Kagey
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Tensha Therapeutics, Inc.
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Priority to RU2016138027A priority Critical patent/RU2722179C2/ru
Priority to KR1020167026021A priority patent/KR20160130778A/ko
Priority to US15/121,964 priority patent/US10925881B2/en
Priority to CA2940472A priority patent/CA2940472A1/en
Priority to SG11201607108XA priority patent/SG11201607108XA/en
Priority to EP15710997.6A priority patent/EP3110424A1/en
Application filed by Tensha Therapeutics, Inc. filed Critical Tensha Therapeutics, Inc.
Priority to MX2016011160A priority patent/MX2016011160A/es
Priority to CN201580010875.2A priority patent/CN106456653A/zh
Priority to JP2016554661A priority patent/JP2017506666A/ja
Priority to AU2015222805A priority patent/AU2015222805B2/en
Publication of WO2015131113A1 publication Critical patent/WO2015131113A1/en
Priority to IL247354A priority patent/IL247354B/en

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/33—Heterocyclic compounds
    • A61K31/395—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/55—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole
    • A61K31/551—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having seven-membered rings, e.g. azelastine, pentylenetetrazole having two nitrogen atoms, e.g. dilazep
    • A61K31/5513—1,4-Benzodiazepines, e.g. diazepam or clozapine
    • A61K31/5517—1,4-Benzodiazepines, e.g. diazepam or clozapine condensed with five-membered rings having nitrogen as a ring hetero atom, e.g. imidazobenzodiazepines, triazolam
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P15/00—Drugs for genital or sexual disorders; Contraceptives
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P3/00—Drugs for disorders of the metabolism
    • A61P3/08—Drugs for disorders of the metabolism for glucose homeostasis
    • A61P3/10—Drugs for disorders of the metabolism for glucose homeostasis for hyperglycaemia, e.g. antidiabetics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P35/00—Antineoplastic agents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P5/00—Drugs for disorders of the endocrine system
    • A61P5/48—Drugs for disorders of the endocrine system of the pancreatic hormones

Definitions

  • Hyperinsulinaemia is characterized by levels of insulin circulating in the blood that are in excess of those expected relative to the level of glucose.
  • Hyperinsulinaemia is a result of unregulated insulin secretion by beta cells of the pancreas despite low blood glucose levels. Hyperinsulinaemia is associated with a variety of conditions such as insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and can occur in patients following gastric bypass surgery. As a result of hyperinsulinaemia, patients suffer from uncontrollable hypoglycemia which causes serious symptoms including headache, dizziness, lethargy, diplopia, blurred vision, unconsciousness, and in cases of severe hypoglycemia seizures, coma and permanent neurological damage.
  • PCOS polycystic ovary syndrome
  • insulinomas are rare pancreatic tumors derived from the insulin producing beta cells of the pancreas. Unlike beta cells that secrete insulin in response to increases in blood glucose, the secretion of insulin by insulinomas is not properly regulated by glucose and the insulinomas continue to secrete insulin causing glucose levels to fall below normal levels. As a result, patients suffer from uncontrollable hypoglycemia causing the above listed symptoms.
  • the present invention features methods for treating a condition associated with hyperinsulinaemia.
  • a first embodiment of the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by Structural Formula I:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C5-C7)heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 - Cio)heteroaryl, wherein each -(Ci-C4)alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 - C7)heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(Ci-C 4 )alkyl, -(d-C ⁇ alkylene-O-CCrC alkyl, or -COO-R4, wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(Ci-C4)alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NRsR ⁇ ;
  • ring A is -(C6-Cio)aryl or -(C 5 -Ci 0 )heteroaryl;
  • each R A is independently H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -Cio)aryl, or -(C 5 -Cio)heteroaryl, wherein each -(C ⁇ - C4)alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(Q-C ⁇ aryl, and - (C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • R is -(CrC 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - C 1 o)aryl, or -(C 5 -C 10 )heteroaryl, wherein each is optionally and
  • Ri is -(CH 2 ) n -L, in which n is 0-3 and L is H, -C(0)0-R 9 , -CO- N(R 9 R 10 ), -NR 9 R 10 , -N(R 10 )C(O)OR 9 , or -N(R 10 )C(O)R 9 ;
  • R 2 is H, D, halogen, or -(Ci-C 4 )alkyl
  • R 5 , and R 6 are each independently selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Ci 0 )aryl, and -(C 5 - C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • Rio is selected from the group consisting of: H, -(Ci-C6)alkyl, -(C 0 - C 6 )alkylene-cycloalkyl, -(Co-C 6 )alkylene-heterocycloalkyl, -(Co-C 6 )alkylene- aryl; and -(C 0 -C 6 )alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(C 0 - C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each -cycloalkyl, -heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R 9 and Rio are taken together with the nitrogen atom to which they are bound form a 4-10-membered ring;
  • R11 is H, -(Ci-C 4 )alkyl, or -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, wherein each -(Ci-C 4 )alkyl, and -(C ! -C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally and independently substituted with 1 to 3 substituents selected from the group consisting of: -F, -CI, -Br, and -OH;
  • Ri2 is H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, - (C 6 -Cio)aryl, or -(C 5 -C 7 )heteroaryl, wherein each -(C 1 -C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C7)heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 - C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents; and
  • n 0, 1, 2, or 3.
  • hyperinsulinaemia is an insulinoma.
  • condition associated with hyperinsulinaemia is congential hyperinsulism.
  • FIG. 1 is a graph showing cell viability of the rat insulinoma cell line, RIN-14B, when treated with varying concentrations of (S)-JQ1 or Paclitaxel.
  • FIG. 2 is a graph showing cell viability of the rat insulinoma cell line, RIN-m5F, when treated with varying concentrations of (S)-JQ1 or Paclitaxel.
  • FIG. 3 is a graph showing cell viability of the rat insulinoma cell line, RIN-m, when treated with varying concentrations of (S)-JQ1 or Paclitaxel.
  • FIG. 4 is a graph showing cell viability of the rat insulinoma cell line, RIN-5F, when treated with varying concentrations of (S)-JQ1 or Paclitaxel.
  • FIG. 5 is a graph showing cell viability of the rat insulinoma cell line, RIN-5F, when treated with varying concentrations of (S)-JQ1 or Paclitaxel.
  • FIG. 6 is a graph showing insulin secretion over time of the rat insulinoma cells, RTN-m5F, when treated with varying concentrations of (S)-JQ1 or (S)-JQ35.
  • FIG. 7 is a graph showing the effect of BET Bromodomain inhibitors, (S)-JQ1 or (S)-JQ35, on gene expression in RTN-m5F cells when Actb is used as an internal control.
  • FIG. 8 is a graph showing the effect of BET Bromodomain inhibitors, (S)-JQ1 or (S)-JQ35, on gene expression in RTN-m5F cells when Gapdh is used as an internal control.
  • FIG. 9 is a graph showing the effect of BET Bromodomain inhibitors, (S)-JQ1 or (S)-JQ35, on gene expression in RIN-m5F cells when 18sRNA is used as an internal control.
  • FIG. 10 is a graph showing the effect of BET Bromodomain inhibitors, (S)-JQ1 or (S)-JQ35, on gene expression in RIN-m cells when Actb is used as an internal control.
  • FIG. 11 is a graph showing the effect of BET Bromodomain inhibitors, (S)-JQ1 or (S)-JQ35, on gene expression in RIN-m cells when Gapdh is used as an internal control.
  • FIG. 12 is a graph showing the effect of BET Bromodomain inhibitors, (S)-JQ1 or (S)-JQ35, on gene expression in RIM-m cells when 18sRNA is used as an internal control.
  • FIG. 13 is a graph showing Brd4 occupancy at the promoter region of the Insulin (Ins2), and c-Myc (Myc) genes and a negative control, untranscribed region Untrl7, as determined by qPCR.
  • FIGS. 14A and 14B show the genome- wide occupancy of the Brd4 and H3 27ac in RIN-m5F cells determined by chromatin immunoprecipitation followed by massively paralleled sequencing (ChlP-Seq).
  • Brd4 occupies the promoters and enhancers of oncogenes (FIG. 14A) and insulin pathway genes (FIG. 14B) in insulinoma cells.
  • FIG. 15 is a graph showing the Brd4 signals determined by ChlP-Seq at each occupied region ranked by the total number of reads.
  • FIG. 16 shows expression changes in exemplary genes following JQ1 treatment of RrN-m5F cells, as determined by sequencing (the RNA-Seq data) and analysis of the library. Arrows denote the transcriptional start site for each gene; thicker lines in the gene models represent exons. DETAILED DESCRIPTION OF THE INVENTION
  • Alkyl means an optionally substituted saturated aliphatic branched or straight-chain monovalent hydrocarbon radical having the specified number of carbon atoms.
  • (Ci-Ce) alkyl means a radical having from 1- 6 carbon atoms in a linear or branched arrangement.
  • (C 1 -C 6 )alkyl includes methyl, ethyl, propyl, iso-propyl (or z-propyl), butyl, sec-butyl, tert-butyl, pentyl, hexyl and the like.
  • Alkylene means an optionally substituted saturated aliphatic branched or straight-chain divalent hydrocarbon radical having the specified number of carbon atoms.
  • (Ci-C 6 )alkylene means a divalent saturated aliphatic radical having from 1- 6 carbon atoms in a linear arrangement, e.g. , -[(CH 2 ) n ]-, where n is an integer from 1 to 6,
  • (Ci-C6)alkylene includes methylene, ethylene, propylene, butylene, pentylene and hexylene.
  • (C 1 -C 6 )alkylene means a divalent saturated radical having from 1-6 carbon atoms in a branched arrangement, for example: -[(CH 2 CH 2 CH 2 CH 2 CH(CH 3 )]-, -[(CH 2 CH 2 CH 2 CH 2 C(CH 3 ) 2 ]-, - [(CH 2 C(CH 3 ) 2 CH(CH 3 ))]-, and the like.
  • a s ecific branched C 3 -alkylene is and a specific C 4 -alkylene is
  • Each alkyl or alkylene in Structural Formulas (I-IX) can be optionally and independently substituted with one or more substituents.
  • Aryl or “aromatic” means an aromatic monocyclic or polycyclic (e.g. bicyclic or tricyclic) carbon-containing ring system.
  • aryl is a 6-12 membered monocyclic or bicyclic system.
  • Aryl systems include, but are not limited to, phenyl, naphthalenyl, fluorenyl, indenyl, azulenyl, and anthracenyl.
  • Cycloalkyl means a saturated aliphatic cyclic hydrocarbon ring.
  • Cycloalkyl includes 3- to 12- membered saturated aliphatic cyclic hydrocarbon rings.
  • (C 3 -C7)cycloalkyl means a hydrocarbon radical of a 3- to 7- membered saturated aliphatic cyclic hydrocarbon ring.
  • a (C 3 -C7)cycloalkyl includes, but is not limited to cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl and cycloheptyl.
  • a cycloalkyl moiety can be monocyclic, fused bicyclic, bridged bicyclic, spiro bicyclic, or polycyclic.
  • monocyclic (C 3 -C 8 )cycloalkyl means a radical having from 3 to 8 carbon atoms arranged in a monocyclic ring.
  • Monocyclic (C 3 -C 8 )cycloalkyl includes, but is not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl and cyclooctane.
  • Monocyclic ring systems have a single ring structure. They include saturated or unsaturated aliphatic cyclic hydrocarbon rings (e.g. , cycloalkyl, cycloalkenyl, or cycloalkynyl) or aromatic hydrocarbon rings (e.g. , aryl) having the specified number of carbon atoms.
  • the monocyclic ring system can optionally contain 1 to 5 heteroatoms in the ring structure wherein each heteroatom is independently selected from the group consisting O, N and S (e.g., heterocycloalkyl, heterocycloalkenyl, heterocycloalkynyl or heteroaryl).
  • the heteroatom When the heteroatom is S, it can be optionally mono- or di-oxygenated (i. e. , -S(O)- or -S(0) 2 -).
  • Examples of monocyclic ring systems include, but are not limited to, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, cycloheptyl, cyclooctane, azetidine, pyrrolidine, piperidine, piperazine, azepane hexahydropyrimidine, tetrahydrofuran, tetrahydropyran, oxepane, tetrahydrothiophene, tetrahydrothiopyran, isoxazolidine, 1 ,3-dioxolane, 1 ,3-dithiolane, 1 ,3-dioxane, 1 ,4-dioxane, 1 ,3-dithiane, 1 ,4-dithiane, morpholine, thiomorpholine, thiomorpholine 1 , 1 -dioxide, tetrahydro-2H
  • Bicyclic ring systems have two rings that have at least one ring atom in common.
  • Bicyclic ring systems include fused, bridged and spiro ring systems.
  • the two rings can both be aliphatic (e.g. , cycloalkyl, cycloalkene, cycloalkyne, or heterocycloalkyl), both be aromatic (e.g. , aryl or heteroaryl), or a combination thereof.
  • the bicyclic ring systems can optionally contain 1 to 5 heteroatoms in the ring structure wherein each heteroatom is independently selected from the group consisting O, N and S.
  • the heteroatom When the heteroatom is S, it can be optionally mono- or di-oxygenated (i.e. -S(0)- or -S(0) 2 -).
  • a fused bicyclic ring system has two rings which have two adjacent ring atoms in common.
  • the two rings can both be aliphatic (e.g., cycloalkyl, cycloalkene, cycloalkyne, or heterocycloalkyl), both be aromatic (e.g., aryl or heteroaryl), or a combination thereof.
  • the first ring can be cycloalkyl or
  • heterocycloalkyl and the second ring can be a cycloalkyl, cycloalkene, cycloalkyne, aryl, heteroaryl or a heterocycloalkyl.
  • the second ring can be a (C 3 - C 6 )cycloalkyl, such as cyclopropyl, cyclobutyl, cyclopentyl and cyclohexyl.
  • the second ring can be an aryl ring (e.g., phenyl).
  • fused bicyclic ring systems include, but are not limited to, 6,7,8,9-tetrahydro-5H- benzo[7]annulene, 2,3-dihydro-lH-indene, octahydro-lH-indene,
  • a spiro bicyclic ring system has two rings which have only one ring atom in common.
  • the two rings can both be aliphatic (e.g., cycloalkyl, cycloalkene, cycloalkyne, or heterocycloalkyl), both be aromatic (e.g. , aryl or heteroaryl), or a combination thereof.
  • the first ring can be a cycloalkyl or a
  • heterocycloalkyl and the second ring can be a cycloalkyl, a cycloalkene, a cycloalkyne, an aryl, a heteroaryl, or a heterocycloalkyl.
  • spiral bicyclic ring systems include, but are not limited to, spiro[2.2]pentane, spiro[2.3]hexane, spiro[3.3]heptane, spiro[2.4]heptane, spiro[3.4]octane, spiro[2.5]octane,
  • azaspiro[4.4]nonane 7-azaspiro[4.4]nonane, azaspiro[4.5]decane, 8- azaspiro[4.5]decane, azaspiro[5.5]undecane, 3-azaspiro[5.5]undecane, and 3,9- diazaspiro [5.5] unde cane .
  • a bridged bicyclic ring system has two rings which have three or more adjacent ring atoms in common.
  • the two rings can both be aliphatic (e.g. , cycloalkyl, cycloalkene, cycloalkyne, or heterocycloalkyl), both be aromatic (e.g. , aryl or heteroaryl), or a combination thereof.
  • the first ring can be a cycloalkyl or a heterocycloalkyl and the other ring is a cycloalkyl, a cycloalkene, a cycloalkyne, an aryl, a heteroaryl or a heterocycloalkyl.
  • bridged bicyclic ring systems include, but are not limited to, bicyclo[1.1.0]butane, bicyclo[1.2.0]pentane, bicyclo[2.2.0]hexane, bicyclo[3.2.0]heptane,
  • Polycyclic ring systems have more than two rings (e.g., three rings resulting in a tricyclic ring system) and adjacent rings have at least one ring atom in common.
  • Polycyclic ring systems include fused, bridged and spiro ring systems.
  • a fused polycyclic ring system has at least two rings that have two adjacent ring atoms in common.
  • a spiro polycyclic ring system has at least two rings that have only one ring atom in common.
  • a bridged polycyclic ring system has at least two rings that have three or more adjacent ring atoms in common.
  • polycyclic ring systems include, but are not limited to, tricyclo[3.3.1.0 3,7 ]nonane (noradamantane), tricyclo[3.3.1.1 3 ' 7 ]decane (adamantane) and 2,3-dihydro-lH-phenalene.
  • Cycloalkene means an aliphatic cyclic hydrocarbon ring having one or more double bonds in the ring.
  • Cycloalkene includes 3- to 12-membered unsaturated aliphatic cyclic hydrocarbon rings.
  • (C 3 -Cv)cycloalkene means a hydrocarbon radical of a 3- to 7- membered unsaturated aliphatic cyclic hydrocarbon ring.
  • a (C 3 -C 7 ) cycloalkene includes, but is not limited to cyclopropenyl, cyclobutenyl, cyclopentenyl, cyclohexenyl and cycloheptenyl.
  • a cycloalkene moiety can be monocyclic, fused bicyclic, bridged bicyclic, spiro bicyclic, or polycyclic.
  • monocyclic (C 3 -C 8 )cycloalkene means a radical having from 3 to 8 carbon atoms arranged in a monocyclic ring.
  • Monocyclic (C 3 -C 8 )cycloalkene includes, but is not limited to, cyclopropenyl, cyclobutenyl, cyclopentenyl, cyclohexenyl and cycloheptenyl.
  • Cycloalkyne means an aliphatic cyclic hydrocarbon ring having one or more triple bonds in the ring.
  • Cycloalkyne includes 3- to 12-membered unsaturated aliphatic cyclic hydrocarbon rings.
  • (C 3 -C 7 )cycloalkyne means a hydrocarbon radical of a 3- to 7-membered unsaturated aliphatic cyclic hydrocarbon ring.
  • a (C 3 -C 7 ) cycloalkyne includes, but is not limited to cyclopropynyl, cyclobutynyl, cyclopentynyl, cyclohexynyl and cycloheptynyl.
  • a cycloalkyne moiety can be monocyclic, fused bicyclic, bridged bicyclic, spiro bicyclic, or polycyclic.
  • monocyclic (C3-C 8 )cycloalkyne means a radical having from 3 to 8 carbon atoms arranged in a monocyclic ring.
  • Monocyclic (C 3 -C 8 )cycloalkyne includes, but is not limited to, cyclopropynyl, cyclobutynyl, cyclopentynyl, cyclohexynyl, and cycloheptynyl.
  • Hetero refers to the replacement of at least one carbon atom member in a ring system with at least one heteroatom selected from N, S, and O. “Hetero” also refers to the replacement of at least one carbon atom member in an acyclic system.
  • a hetero ring system or a hetero acyclic system may have 1, 2, 3, 4 or 5 carbon atoms members replaced by a heteroatom.
  • Heterocycloalkyl means a cyclic 4- to 12-membered saturated aliphatic ring containing 1 , 2, 3, 4 or 5 heteroatoms independently selected from N, O or S. When one heteroatom is S, it can be optionally mono- or di-oxygenated (i.e. -S(O)- or -S(0) 2 -).
  • a heterocycloalkyl moiety can be monocyclic, fused bicyclic, bridged bicyclic, spiro bicyclic, or polycyclic.
  • monocyclic (C 3 -C 8 ) heterocycloalkyl means a 3- to 8 membered saturated aliphatic ring containing 1, 2, 3, 4, or 5 heteroatoms independently selected from N, O or S arranged in a monocyclic ring.
  • monocyclic heterocycloalkyls include, but are not limited to, azetidine, pyrrolidine, piperidine, piperazine, azepane,
  • thiomorpholine thiomorpholine 1,1 -dioxide, tetrahydro-2H-l,2-thiazine, tetrahydro- 2H-l,2-thiazine 1,1 -dioxide, isothiazolidine, isothiazolidine 1,1 -dioxide.
  • Heteroaryl or "heteroaromatic ring” means a 5- to 12-membered monovalent heteroaromatic monocyclic or bicyclic ring radical.
  • a heteroaryl contains 1, 2, 3, 4, or 5 heteroatoms independently selected from N, O, and S.
  • Heteroaryls include, but are not limited to furan, oxazole, thiophene, 1,2,3-triazole,
  • Bicyclic heteroaryl rings include, but are not limited to, bicyclo[4.4.0] and bicyclo[4.3.0] fused ring systems such as indolizine, indole, isoindole, indazole, benzimidazole, benzothiazole, purine, quinoline, isoquinoline, cinnoline, phthalazine, quinazoline, quinoxaline, benzofuran, 1,8-naphthyridine, and pteridine.
  • bicyclo[4.4.0] and bicyclo[4.3.0] fused ring systems such as indolizine, indole, isoindole, indazole, benzimidazole, benzothiazole, purine, quinoline, isoquinoline, cinnoline, phthalazine, quinazoline, quinoxaline, benzofuran, 1,8-naphthyridine, and pteridine.
  • each cycloalkyl, cycloalkene, cycloalkyne, cycloheterocycloalkyl, aryl and heteroaryl is optionally and independently substituted with 1 to 4.
  • Halogen refers to fluorine, chlorine, bromine, or iodine.
  • Alkoxy means an alkyl radical attached through an oxygen linking atom.
  • (Ci-C 6 )alkoxy includes methoxy, ethoxy, propoxy, butoxy, pentoxy and hexoxy.
  • Haloalkyl and halocycloalkyl include mono, poly, and perhalo- substituted alkyl or cycloalkyl groups where each halogen is independently selected from fluorine, chlorine, and bromine.
  • Halogen and halo are interchangeably used herein and each refers to fluorine, chlorine, bromine, or iodine.
  • Fruoro means -F.
  • fluoro-substituted (Ci-C 4 )alkyl means a (C ! -C 4 )alkyl substituted with one or more -F groups.
  • fluoro-substituted-l i- C 4 )alkyl include, but are not limited to, -CF 3 , -CH 2 CF 3 , -CH 2 CF 2 H, -CH 2 CH 2 F and - CH 2 CH 2 CF 3 .
  • Naturally occurring amino acid side chain moiety refers to any amino acid side chain moiety present in a natural amino acid.
  • the present invention is directed to method of treating a condition associated with hyperinsulinaemia ⁇ e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by Formulas (I-IX) or a pharmaceutically acceptable salt thereof.
  • a condition associated with hyperinsulinaemia is an insulinoma.
  • the condition associated with hyperinsulinaemia is congenital hyperinsulinism.
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of : H and -(Cj- C 4 )alkyl. Further, R 3 is selected from the group consisting of: H, methyl, ethyl, propyl, butyl, sec-butyl and tert-butyl. Specifically, R 3 is H or methyl.
  • R B is H, -(Ci-C 4 )alkyl, -(C 1 -C 4 )alkylene-0-(C 1 -C 4 )alkyl, or -COO-R ⁇ wherein each -(Cj-C 4 )alkyl and -(C 1 -C 4 )alkylene-0-(C 1 -C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR 5 R 6 ;
  • R B is H, -(C C 4 )alkyl, or -(C 1 -C 4 )alkylene-0-(C 1 - C 4 )alkyl, wherein each is optionally substituted with 1 to 4 substituents
  • RB is H, methyl, ethyl, propyl, butyl, sec-butyl, tert-butyl, - COOH, -COOMe, -COOEt, -COOCH 2 OC(0)CH 3 , trifluoromethyl, -CF 2 -CF 3 , methoxymethyl, methoxyethyl, methoxypropyl, ethoxymethyl, ethoxyethyl, methoxytrifluoromethyl, -CH 2 -0-CF 2 -CF 3 , hydroxymethyl, hydroxyethyl, -CH 2 - NH 2 , -(CH 2 ) 2 -NH 2 , -CH 2 -NHCH 3 , or -(CH 2 ) 2 -NHCH 3 .
  • R B is H, methyl, ethyl, trifluoromethyl, methoxymethyl, ethoxymethyl, hydroxymethyl, hydroxyethyl, -CH 2 -NH 2 , or -(CH 2 ) 2 -NH 2 .
  • RB is H, methyl, ethyl, trifluoromethyl, methoxymethyl, ethoxymethyl, hydroxymethyl, or -CH 2 -NH 2 .
  • RB is H.
  • Ring A is -(C 6 -Cio)aryl or -(C 5 -C 10 )heteroaryl.
  • ring A is thiofuranyl, phenyl, naphthyl, biphenyl, tetrahydronaphthyl, indanyl, pyridyl, furanyl, indolyl, pyrimidinyl, pyridizinyl, pyrazinyl, imidazolyl, oxazolyl, thienyl, thiazolyl, triazolyl, isoxazolyl, quinolinyl, pyrrolyl, pyrazolyl, or 5,6,7,8- tetrahydroisoquinolinyl.
  • ring A is 5- or 6-membered aryl or heteroaryl.
  • Ring A is thiofuranyl, phenyl, pyridyl, furanyl, indolyl, pyrimidinyl, pyridizinyl, pyrazinyl, imidazolyl, oxazolyl, thienyl, thiazolyl, triazolyl, isoxazolyl, pyrrolyl, or pyrazolyl.
  • ring A is phenyl or thienyl. Specifically, ring A is thienyl.
  • each RA is independently H or -(C 1 -C 4 )alkyl.
  • Each RA is independently H, methyl, ethyl, propyl, butyl, sec-butyl, or tert-butyl.
  • each R A is independently H or methyl.
  • any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group. Further, any two RA together with the atoms to which each is bound form a fused aryl.
  • R is -(C r C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, or -(C5-Cio)heteroaryl, wherein each is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci-C 4 )alkyl, -0-(C C 4 )alkyl, -(d-C 4 )alkylene-0 -(C 1 -C 4 )alkyl, halo-substituted- (C C 4 )alkyl, halo-substituted-O- (C C 4 )alkyl, -C(0)-(C 1 -C 4 )alkyl, -C(0)-(fluoro- substitute
  • R is-(C 6 -C 1 o)aryl, or -(C5-Cio)heteroaryl, wherein each is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(C r C 4 )alkyl, -O-Cd-C ⁇ alkyl, -(C C 4 )alkylene-0 -(Ci-C )alkyl, halo-substituted-(C r C 4 )alkyl, halo-substituted-0-(Ci-C 4 )alkyl, - C(0)-(C r C 4 )alkyl, -C(0)-(fluoro-substituted-(C]-C 4 )alkyl), -S(0) 0 -(C ! -C 4 )alkyl, - NR 7 R 8 and
  • R is phenyl or pyridinyl, wherein each is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, - OH, -(C !
  • -C 4 )alkyl -O-Cd-C ⁇ alkyl, -(Ci-C 4 )alkylene-0 -(C r C 4 )alkyl, halo- substituted-(Ci-C 4 )alkyl, halo-substituted-0-(d-C 4 )alkyl, -C(0)-(C 1 -C 4 )alkyl, - C(0)-(fluoro-substituted-(C]-C 4 )alkyl), -S(0) 0 -(C ! -C 4 )alkyl, -NR 7 R 8 and CN.
  • R is phenyl or pyridinyl wherein each is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, - methyl, ethyl, propyl, butyl, sec-butyl, tert-butyl, -COOH, -COOMe, - COOEt, -COOCH 2 OC(0)CH 3 , trifluoromethyl, -CF 2 -CF 3 , methoxymethyl, methoxyethyl, methoxypropyl, ethoxymethyl, ethoxyethyl, methoxytrifluoromethyl, -CH 2 -0-CF 2 -CF 3 , hydroxymethyl, hydroxyethyl, -CH 2 -NH 2 , -(CH 2 ) 2 -NH 2 , -CH 2 - NHCH 3 , -(CH 2 ) 2 - -(CH 2
  • R is phenyl optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -and OH.
  • R is phenyl optionally substituted with 1 to 3 substituents independently selected from the group consisting of: -F, -CI, -Br, -and OH.
  • R is phenyl optionally substituted with a substituent independently selected from the group consisting of: - F, -CI, -Br, -and OH.
  • R is p-Cl-phenyl, o-Cl-phenyl, m-Cl-phenyl, p-F- phenyl, o-F-phenyl, m-F-phenyl or pyridinyl.
  • Ri is -(CH 2 ) n -L, in which n is 0-3 and L is H, -C(0)0-R 9 , -CO- N(R 9 Rio), -NR 9 Rio, -N(Ri 0 )C(O)OR 9 , or -N(Ri 0 )C(O)R 9 .
  • Ri is -(CH 2 ) n -L, in which n is 0-3, and L is-C(0)0-R 9 .
  • Ri is -(CH 2 ) n -L, in which n is 1-3, and L is-C(0)0-R 9 .
  • Ri is-(CH 2 ) n -L, in which n is 1-2, and L is-C(0)0-R 9 .
  • Ri is-(CH 2 ) n -L, in which n is 1, and L is -C(0)0-R 9 .
  • 3 ⁇ 4 is -(CH 2 ) n -L, in which n is 0-3, and L is -CO-N(R 9 Ri 0 ).
  • Ri is -(CH 2 )n-L, in which n is 1-3, and L is -CO-N(R 9 Ri 0 ).
  • Ri is -(CH 2 ) n -L, in which n is 1-2, and L is -CO-N(R 9 Ri 0 ).
  • Ri is -(CH 2 ) n -L, in which n is 1, and L is -CO-N(R 9 Ri 0 ).
  • Ri is -(CH 2 ) n -L, in which n is 0-3, and L is - NR 9 Rio.
  • Ri is -(CH 2 )n-L, in which n is 1-3, and L is -NR 9 Ri 0 .
  • Ri is - (CH 2 ) n -L, in which n is 1-2, and L is -NR 9 Ri 0 .
  • Ri is -(CH 2 ) n -L, in which n is 1 , and L is -NR 9 Rio.
  • Ri is -(CH 2 ) n -L, in which n is 0-3, and L is -N(Ri 0 )C(O)OR 9 .
  • Ri is -(CH 2 ) n -L, in which n is 1-3, and L is -N(Ri 0 )C(O)OR 9 .
  • Ri is -(CH 2 ) n -L, in which n is 1-2, and L is -N(Ri 0 )C(O)OR 9 .
  • Ri is - (CH 2 ) n -L, in which n is 1 , and L is -N(Ri 0 )C(O)OR 9 .
  • R 1 is -(CH 2 ) n -L, in which n is 0-3, and L is -N(R 10 )C(O)R 9 .
  • Ri is -(CH 2 ) n -L, in which n is 1-3, and L is -N(R 10 )C(O)R 9 .
  • R 1 is -(CH 2 )n-L, in which n is 1-2, and L is -N(Rio)C(0)R 9 .
  • R 1 is - (CH 2 )n-L, in which n is 1, and L is -N(R 10 )C(O)R 9 .
  • Ri is -(CH 2 ) n -L, in which n is 0-3 and L is H. Ri is methyl, ethyl, propyl, iso-propyl. Specifically, Ri is methyl.
  • R 2 is H, D, halogen, or -(C 1 -C 4 )alkyl. Alternatively, R 2 is H or -(d- C 4 )alkyl. Further, R 2 is H, methyl, ethyl, propyl, iso-propyl, butyl, sec-butyl or tert- butyl. Specifically, R 2 is H or methyl.
  • R4 is selected from the group consisting of: H, -(C C ⁇ alkyl, -(C 3 - C 8 )cycloalkyl, -(C5-C7)heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C5-C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Cj- C 4 )alkyl, -0-(C,-C 4 )alkyl, -(C,-C 4 )alkylene
  • R4 is selected from the group consisting of: H and -(Ci- C 4 )alkyl, wherein each -(C 1 -C 4 )alkyl is optionally substituted with 1 to 4
  • substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, - (Ci-C 4 )alkyl, -0-(C,-C 4 )alkyl, -(Ci-C 4 )alkylene-0-(C r C 4 )alkyl, halo-substituted- (Ci-C 4 )alkyl, halo-substituted-0-(C,-C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, and -C(O)- (fluoro- substituted-(C 1 -C 4 )alkyl).
  • R4 is selected from the group consisting of: H and -(Ci-C 4 )alkyl, wherein each -(Ci-C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, and -OH.
  • R4 is selected from the group consisting of: H, methyl, ethyl, propyl, iso-propyl, butyl, sec-butyl, tert-butyl, trifluoromethyl, -CF 2 -CF 3 , hydroxymethyl, and hydroxyethyl.
  • R4 is selected from the group consisting of: H, methyl, ethyl, tert-butyl, and trifluoromethyl.
  • R 5 is selected from the group consisting of: H, -(Cj-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(Cs-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(Cs-C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci- C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(Ci-C 4
  • halo-substituted-(C r C 4 )alkyl halo-substituted-0-(Ci-C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, and -C(0)-(fluoro- substituted-(C i -C 4 )alkyl).
  • R 5 is selected from the group consisting of: H, -(C ⁇ - C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci-C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(C
  • R 5 is selected from the group consisting of: H, -(C 1 -C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(Ci-C 4 )alkyl.
  • R 5 is selected from the group consisting of: H, methyl, ethyl, propyl, iso- propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • R 6 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(C 1 -C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C - Cio)aryl, and -(C5-C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci- C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(Ci-
  • R 6 is selected from the group consisting of: H, -(Ci- C 4 )alkyl, and -(C 3 -Cs)cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci-C 4 )alkyl, -0-(C r C 4 )alkyl, -(d- C 4 )alkylene-0-(Ci -C 4 )alkyl, halo-substituted-(C 1 -C 4 )alkyl, halo-substituted-0-(C l - C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, and -C(0)-(fluoro- substitute
  • R 6 is selected from the group consisting of: H, -(Q-C ⁇ alkyl, and -(C 3 -Cg)cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(Ci-C 4 )alkyl.
  • R 7 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - Cg)cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C5-C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci- C 4 )alkyl, -0-(C C 4 )alkyl, -(Ci-C 4 )al
  • R 7 is selected from the group consisting of: H, -(C ⁇ - C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci-C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(d- C 4 )alkylene-0-(C r C 4 )alkyl, halo-substituted-(Ci-C 4 )alkyl, halo-substituted-0-(Ci- C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, and -C(0)-(fluoro-substit
  • R 7 is selected from the group consisting of: H, -(Q-G alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(C C 4 )alkyl.
  • R 7 is selected from the group consisting of: H, methyl, ethyl, propyl, iso- propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • R 8 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Ci 0 )aryl, and -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C - Cio)aryl, and -(C 5 -C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Q- C 4 )alkyl, -O-CQ-C ⁇ alkyl, -(C 1 -
  • R 8 is selected from the group consisting of: H, -(Ci- C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl wherein each -(C 1 -C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(d-C 4 )alkyl, -0-(C C 4 )alkyl, -(C r
  • R 8 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(Ci-C 4 )alkyl.
  • R 8 is selected from the group consisting of: H, methyl, ethyl, propyl, iso- propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • R 9 is selected from the group consisting of: H, methyl, ethyl, propyl, i-propyl, butyl, sec-butyl, t-butyl, and trifluoromethyl.
  • R 9 is selected from the group consisting of -(C 1 -C 3 )alkylene-morpholine, -(Cj- C 3 )alkylene-piperazine, -(C 1 -C 3 )alkylene-phenyl, -(C 1 -C 3 )alkylene-pyridyl, -(Ci- C 3 )alkylene-imidazolyl, -(C 1 -C 3 )alkylene-azetidine, -(C 1 -C 3 )alkylene-furanyl, -(Cj- C 3 )alkylene-pyrazinyl, -(C 1 -C 3 )alkylene-oxazolyl, -
  • R 9 is selected from the group consisting of - (Ci-C 3 )alkylene-morpholine, -(Ci-C 3 )alkylene-piperazine, -(C 1 -C 3 )alkylene-phenyl, -(C 1 -C 3 )alkylene-pyridyl, and -(Ci-C 3 )alkylene-imidazolyl, wherein each -(Ci- C 3 )alkylene-, -morpholine, -piperazine, -phenyl, -pyridyl, and -imidazolyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -B(OH) 2 , and -(Ci-C 4 )alkyl.
  • halo-substituted- (Ci-C 4 )alkyl halo-substituted-0-(Ci-C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, -C(0)-(fluoro-substituted-(Ci-C 4 )alkyl), -S(0) q -(Ci-C 4 )alkyl, -NRi 5 Ri 6 and CN.
  • R 10 is selected from the group consisting of: H, methyl, ethyl, propyl, iso-propyl, butyl, sec-butyl, tert- butyl, trifluoromethyl, -(Ci-C 3 )alkylene-morpholine, -(Ci-C 3 )alkylene-piperazine, - (Ci-C 3 )alkylene-phenyl, -(Ci-C 3 )alkylene-pyridyl, and -(Ci-C 3 )alkylene-imidazolyl, wherein each -(Ci-C 3 )alkylene-, -morpholine, -piperazine, -phenyl, -pyridyl, and - imidazolyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -B(OH) 2 , and -(Ci-C 4 )alkyl.
  • R 9 and Ri 0 are taken together with the nitrogen atom to which they are bound form a 4-10-membered ring.
  • R 9 and Ri 0 are taken together with the nitrogen atom to which they are bound form a 4-6-membered ring.
  • R 9 and Rio are taken together with the nitrogen atom to which they are bound form a 4- 6-membered ring cycloalkyl or heterocycloalkyl.
  • [00105] is H, -(C,-C 4 )alkyl, or -(C,-C 4 )alkylene-0-(Ci-C 4 )alkyl, wherein each -(C)-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally substituted with 1 to 3 substituents independently selected from the group consisting of: -F, -CI, -Br, and -OH.
  • R n is H or -(Ci-C 4 )alkyl optionally substituted with 1 to 3 substituents independently selected from the group consisting of: -F, -CI, -Br, and -OH.
  • R] i is H, methyl, ethyl, propyl, butyl, or trifluoromethyl.
  • Rn is H or methyl.
  • R 12 is H, phenyl, imidazolyl, furanyl, or indolyl, wherein each phenyl, imidazolyl, furanyl, or indolyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -OH, methyl, - S(0) 2 -Na, or -B(OH) 2 ,
  • R 13 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C5-C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(C ⁇ - C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(C r C 4
  • Rj 3 is selected from the group consisting of: H, -(Q- C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C8)cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(C C 4 )alkyl, -0-(C r C 4 )alkyl, -(Q- C 4 )alkylene-0-(C 1 -C 4 )alkyl, halo-substituted-(Ci-C 4 )alkyl, halo-substituted-0-(C 1 - C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, and -C(0)-(fiuoro-substitute
  • R 13 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -Cs)cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(C]-C 4 )alkyl.
  • R 13 is selected from the group consisting of: H, methyl, ethyl, propyl, iso-propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • R 14 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -Cs)cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -C7)heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(d- C 4 )alkyl, -0-(C C 4 )alkyl, -(Ci-C 4 )alkylene
  • Ri 4 is selected from the group consisting of: H, -(d- C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(C r C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(d- C 4 )alkylene-0-(Ci-C 4 )alkyl, halo-substituted-(Ci-C 4 )alkyl, halo-substituted-0-(C 1 - C 4 )alkyl, -C(0)-(C 1 -C 4 )alkyl, and -C(0)-(fluoro-substit
  • Rj 4 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(C ! -C 4 )alkyl, and halo-substituted-(C 1 -C 4 )alkyl.
  • R 14 is selected from the group consisting of: H, methyl, ethyl, propyl, iso-propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • Ri 5 is selected from the group consisting of: H, -(d-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C7)heterocycloalkyl, -(C6-Cio)aryl, and -(C5-C7)heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C7)heterocycloalkyl, -(C 6 - C 1 o)aryl, and -(C 5 -C7)heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Cj- C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(C 1 -C 4 )alky
  • R 15 is selected from the group consisting of: H, -(d- C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(d-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Ci-C 4 )alkyl, -0-(d-C 4 )alkyl, -(d- C 4 )alkylene-0-(d-C 4 )alkyl, halo-substituted-(Ci-C 4 )alkyl, halo-substituted-0-(Cr C 4 )alkyl, -C(0)-(d-C 4 )alkyl, and -C(0)-(fluoro-substituted-(C 1 )
  • Ri 5 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(Ci-C 4 )alkyl.
  • Ri 5 is selected from the group consisting of: H, methyl, ethyl, propyl, iso-propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • R 16 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -C 10 )aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -C 7 )heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(Cj- C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(C
  • Ri 6 is selected from the group consisting of: H, -(Q- C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, -OH, -(C r C 4 )alkyl, -0-(Ci-C 4 )alkyl, -(Ci- C 4 )alkylene-0-(Ci-C 4 )alkyl, halo-substituted-(C]-C 4 )alkyl, halo-substituted-0-(Ci- C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, and -C(0)-(fluoro-substitute
  • Rj 6 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, and -(C 3 -C 8 )cycloalkyl, wherein each -(Ci-C 4 )alkyl and -(C 3 -C 8 )cycloalkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -OH, -0-(Ci-C 4 )alkyl, and halo-substituted-(Ci-C 4 )alkyl.
  • Ri 6 is selected from the group consisting of: H, methyl, ethyl, propyl, iso-propyl, butyl, tert-butyl, methoxy, hydroxyl, cyclobutyl, cyclopentyl, and cyclohexyl.
  • Rc is selected from the group consisting of: -F, -CI, -Br, -OH, -(Cj- C 4 )alkyl, -0-(C C 4 )alkyl, -(Ci-C 4 )alkylene-0 -(C C 4 )alkyl, halo-substituted-(Ci- C 4 )alkyl, halo-substituted-0-(Ci-C 4 )alkyl, -C(0)-(Ci-C 4 )alkyl, -C(0)-(fluoro- substituted -(Ci-C 4 )alkyl), -S(0) 0 -(Ci-C 4 )alkyl, -NR 7 R 8 and CN.
  • Rc is selected from the group consisting of: -F, -CI, -Br, - OH, and -0-(Ci-C 4 )alkyl.
  • Rc is selected from the group consisting of F, -CI, -Br, -OH, methoxy, and ethoxy.
  • n is 0, 1 , 2, or 3. Alternatively, m is 1 or 2.
  • o is 1 or 2.
  • p is 1 or 2.
  • q is 1 or 2.
  • r is 1 or 2.
  • a first embodiment of the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by Structural Formula I:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C5-C7)heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -Cio)heteroaryl, wherein each -(Q-G alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C7)heterocycloalkyl, -(C 6 - Cio)aryl, and -(C5-Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(Ci-C 4 )alkyl, -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, or -COO-R4, wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(C 1 -C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR 5 R 6 ; [00132] ring A is -(C 6 -Ci 0 )aryl or -(C 5 -C 10 )heteroaryl;
  • each R A is independently H, -(C 1 -C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -C 10 )aryl, or -(C 5 -C 1 o)heteroaryl, wherein each -(d-C 4 )alkyl, - (C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • R is -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, or -(C 5 -C 1 o)heteroaryl, wherein each is optionally and independently substituted with 1 to 4 substituents;
  • Ri is -(CH 2 )n-L, in which n is 0-3 and L is H, -C(0)0-R 9 , -CO- N(R 9 R 10 ), -NR 9 R 10 , -N(Rio)C(0)OR 9 , or -N(Ri 0 )C(O)R 9 ;
  • R 2 is H, D, halogen, or -(Ci-C 4 )alkyl
  • Rt, R 5 are each independently selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Ci 0 )ar l, and -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 - C 7 )heterocycloalkyl, -(C 6 -C 1 o)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R 10 is selected from the group consisting of: H, -(Ci-C 6 )alkyl, -(C 0 - C6)alkylene-cycloalkyl, -(Co-C 6 )alkylene-heterocycloalkyl, -(Co-C 6 )alkylene-aryl; and -(Co-C6)alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(Co-C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each - cycloalkyl, -heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R 9 and Rio are taken together with the nitrogen atom to which they are bound form a 4-10-membered ring;
  • Ri i is H, -(Ci-C 4 )alkyl, or -(C,-C 4 )alkylene-0-(C,-C 4 )alkyl, wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally and independently substituted with 1 to 3 substituents selected from the group consisting of: -F, -CI, -Br, and -OH;
  • Ri2 is H, -(d-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, - (C 6 -Cio)aryl, or -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -Cg)cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents; and
  • m is 0, 1 , 2, or 3.
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • RB is H or -(C G ⁇ alkyl.
  • ring A is 5- or 6-membered aryl or heteroaryl.
  • ring A is phenyl or thienyl.
  • R is -(C6-Cio)aryl or -(C5-Cio)heteroaryl optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, and -Br.
  • L is H, -COO-R9, or -CO-N(R 9 Ri 0 ).
  • each R 9 is independently selected from the group consisting of -(C 1 -C 6 )alkyl, -(Co-C6)alkylene-heterocycloalkyl, -(Co-C6)alkylene-aryl, and -(C 0 - C 6 )alkylene-heteroaryl and each -(C]-C6)alkyl, -heterocycloalkyl, -aryl, and - heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -(Ci-C6)alkyl.
  • each Rio is independently selected from the group consisting of: H and -(C 1 -C 6 )alkyl.
  • R 2 is selected from the group consisting of: H and methyl.
  • RA is independently H or -(Ci-C 4 )alkyl, or any two RA together with the atoms to which each is attached, can form a fused aryl.
  • m is 2 and and at least one RA is methyl.
  • m is 2 and each R A is methyl.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia ⁇ e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by Structural Formula II:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - Cs)cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-Cio)heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C3-C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - C 10 )aryl, and -(C 5 -C 1 o)rieteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(Ci-C 4 )alkyl, -(C r C 4 )alkylene-0-(C 1 -C 4 )alkyl, or -COO-R4, wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR5R6;
  • each R A is independently H, -(C r C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C7) heterocycloalkyl, -(C 6 -Cio)aryl, or -(C 5 -Cio)heteroaryl, wherein each -(Ci-C 4 )alkyl, - (C 3 -C 8 )cycloalkyl, -(C5-C7) heterocycloalkyl, -(C 6 -C 10 )aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • R is -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, or -(C 5 -Cio)heteroaryl, wherein each is optionally and independently substituted with 1 to 4 substituents;
  • L is H, -C(0)0-R 9 , -CO-N(R 9 Ri 0 ), -NR 9 Ri 0 , -N(R 10 )C(O)OR 9 , or - N(R 10 )C(O)R 9 ;
  • R 4 , R 5 are each independently selected from the group consisting of: H, -(Q-C ⁇ alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -C 10 )aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Q-C ⁇ alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 - C 7 )heterocycloalkyl, -(C 6 -C 1 o)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R 10 is selected from the group consisting of: H, -(Ci-C 6 )alkyl, -(C 0 - C 6 )alkylene-cycloalkyl, -(C 0 -C 6 )alkylene-heterocycloalkyl, -(Co-C6)alkylene-aryl; and -(C 0 -C 6 )alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(C 0 -C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each - cycloalkyl, -heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R- 9 and R 10 are taken together with the nitrogen atom to which they are bound form a 4-10-membered ring;
  • Rii is H, -(Ci-C 4 )alkyl, or -(Ci-C 4 )alkylene-0-(C r C 4 )alkyl, wherein each-(Ci-C 4 )alkyl and -(C 1 -C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally substituted with 1 to 3 substituents selected from the group consisting of: -F, -CI, -Br, and -OH;
  • Ri2 is H, -(C ! -C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, - (C 6 -C 1 o)aryl, or -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C8)cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents; and
  • m is 0, 1 , 2, or 3.
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • RB is selected from the group consisting of: H, -(Ci-C 4 ) alkyl, and -(Ci-C 4 )alk lene-0-(Ci-C 4 )alkyl, and each -(C,-C 4 ) alkyl and -(Ci-C 4 )alkylene- 0-(Ci-C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, and -OH.
  • RB is methyl, ethyl, hydroxy methyl, methoxymethyl, or trifluoromethyl.
  • R is -(C 6 -Cio)aryl, or -(C 5 -Cio)heteroaryl optionally substituted with a substituent selected from the group consisting of: -F, -CI, and -Br.
  • R is phenyl or pyridyl optionally substituted with a substituent selected from the group consisting of: -F, -CI, and -Br.
  • R is p-Cl-phenyl, o-Cl-phenyl, m-Cl-phenyl, p-F-phenyl, o-F- phenyl, m-F-phenyl or pyridinyl.
  • L is -CO-N(R 9 R 10 )
  • R 9 is -(C 0 -C 6 )alkylene-heterocycloalkyl, - (C 0 -C 6 ) alkylene-aryl, or -(Co-C 6 )alkylene- heteroaryl, wherein each - heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 (Ci-C 4 )alkyl
  • Ri 0 is H or -(CrC 6 )alkyl.
  • L is -COO-R9 and R9 is independently selected from the group consisting of: -(Ci-C 6 )alkyl, -(C 0 -C6)alkylene -heterocycloalkyl, -(C 0 - C 6 )alkylene-aryl, and -(C 0 -C 6 )alkylene-heteroaryl, wherein each -(C 1 -C 6 )alkyl, - heterocycloalkyl, -aryl, and -heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, -Br, and - (d-C 6 )alkyl.
  • L is -COO-R9
  • R9 is selected from the group consisting of: methyl, ethyl, propyl, i-propyl, butyl, sec-butyl, t-butyl, and trifluoromethyl.
  • each RA is independently H or -(Ci-C 4 )alkyl, or any two RA together with the atoms to which each is attached, can form a fused aryl.
  • m is 2, and at least one occurrence of RA is methyl.
  • m is 2 and each RA is methyl.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith-Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by Structural Formula III:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith-Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - Cg)cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Ci 0 )aryl, and -(C 5 -Cio)heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(Ci-C 4 )alkyl, -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, or -COO-R ⁇ wherein each -(Ci-C )alkyl and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR 5 6;
  • ring A is -(C 6 -Ci 0 )aryl or -(C 5 -Ci 0 )heteroaryl;
  • each R A is independently H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C7) heterocycloalkyl, -(C 6 -Cio)aryl, or -(C5-Cio)heteroaryl, wherein each -(Ci-C 4 )alkyl, - (C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -Cio)aryl, and -(C5-C 1 o)heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • R is -(C r C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, or -(C5-Cio)heteroaryl, wherein each is optionally and independently substituted with 1 to 4 substituents;
  • R4, R 5 , and R 6 are each independently selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Ci 0 )aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 - C7)heterocycloalkyl, -(C 6 -Ci 0 )aryl, and -(C5-C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R 9 is selected from the group consisting of: H, -(Ci-C 6 )alkyl, -(C 0 - C 6 )alkylene-cycloalkyl, -(C 0 -C 6 )alkylene-heterocycloalkyl, -(Co-C 6 )alkylene-aryl, and -(Co-C 6 )alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(C 0 -C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each - cycloalkyl, -heterocycloalkyi, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents; and
  • m is 0, 1, 2, or 3.
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • RB is selected from the group consisting of: H, -(C1-C4) alkyl, and -(Ci-C 4 )alkylene-0-(C r C 4 )alkyl, and each -(C 1 -C4) alkyl and
  • 0-(Ci-C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -OH.
  • RB is methyl, ethyl, hydroxy methyl, methoxymethyl, or trifluoromethyl.
  • ring A is 5- or 6-membered aryl or heteroaryl.
  • ring A is thiofuranyl, phenyl, naphthyl, biphenyl,
  • ring A is phenyl or thienyl.
  • R is -(Ce-C ⁇ aryl or -(Cs-C ⁇ heteroaryl optionally substituted with a substituent selected from the group consisting of: -F, -CI, and -Br.
  • R is phenyl or pyridyl optionally substituted with 1 -4 substituents independently selected from the group consisting of: -F, -CI, and -Br.
  • R is p-Cl-phenyl, o-Cl-phenyl, m-Cl-phenyl, p-F-phenyl, o-F- phenyl, m-F-phenyl or pyridinyl.
  • each RA is independently H or -(Ci-C 4 )alkyl, or any two RA together with the atoms to which each is attached, can form a fused aryl.
  • m is 2, and at least one occurrence of RA is methyl.
  • m is 2 and each R A is methyl.
  • R 9 is independently selected from the group consisting of -(Cr C 6 )alkyl, -(Co-C6)alkylene -heterocycloalkyl, -(Co-C6)alkylene-aryl, and -(C 0 - C6)alkylene-heteroaryl and each -(Ci-C 6 )alkyl, -heterocycloalkyl, -aryl, and - heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -(Ci-C6)alkyl.
  • R 9 is selected from the group consisting of: methyl, ethyl, propyl, i-propyl, butyl, sec-butyl, t-butyl, and trifluorom ethyl.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by Structural Formula IV:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -Cio)heteroaryl, wherein each -(Ci-C4)alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(C r C 4 )alkyl, -(C r C 4 )alkylene-0-(Ci-C 4 )alkyl, or -COO-R4, wherein each -(Ci-C 4 )alkyl and is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR 5 R 6 ;
  • ring A is aryl or heteroaryl
  • each R A is independently H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C7) heterocycloalkyl, -(C6-Ci 0 )aryl, or -(Cs-C ⁇ heteroaryl, wherein each -(CrC ⁇ alkyl, - (C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C6-C 10 )aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • R is -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, or -(C 5 -Cio)heteroaryl, wherein each is optionally and independently substituted with 1 to 4 substituents;
  • R4, R 5 , and R 6 are each independently selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Ci 0 )aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 - C 7 )heterocycloalkyl, -(C6-Ci 0 )aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • Rio is selected from the group consisting of: H, -(Ci-C 6 )alkyl, -(C 0 - C 6 )alkylene-cycloalkyl, -(Co-C 6 )alkylene-heterocycloalkyl, -(Co-C 6 )alkylene-aryl; and -(C 0 -C 6 )alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(C 0 -C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each - cycloalkyl, -heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • Rg and Rio are taken together with the nitrogen atom to which they are bound form a 4-10-membered ring;
  • R,i is H, -(Ci-C 4 )alkyl, or -(Ci-C 4 )alkylene-0-(C r C 4 )alkyl, wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally substituted with 1 to 3 substituents selected from the group consisting of: -F, -CI, -Br, and -OH;
  • Ri2 is H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, - (C 6 -Cio)aryl, or -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C4)alkyl, -(C 3 -C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C6-C 10 )aryl, and -(C5-C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents; and
  • m is 0, 1, 2, or 3.
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • RB is selected from the group consisting of: H, -(Ci-C 4 ) alkyl, and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, and each -(d-C 4 ) alkyl and
  • 0-(Ci-C4)alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -OH.
  • RB is methyl, ethyl, hydroxy methyl, methoxymethyl, or trifluoromethyl.
  • ring A is 5- or 6-membered aryl or heteroaryl.
  • ring A is thiofuranyl, phenyl, naphthyl, biphenyl,
  • ring A is phenyl or thienyl.
  • R is -(C6-C 10 )aryl, or -(C5-Ci 0 )heteroaryl optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, and -Br.
  • R is phenyl or pyridyl optionally substituted with 1 to 4 substituents independently selected from the group consisting of: -F, -CI, and -Br.
  • R is p-Cl-phenyl, o-Cl-phenyl, m-Cl-phenyl, p-F-phenyl, o-F- phenyl, m-F-phenyl or pyridinyl.
  • each RA is independently H or -(C 1 -C 4 )alkyl, or any two RA together with the atoms to which each is attached, can form a fused aryl.
  • m is 2, and at least one occurrence of RA is methyl.
  • m is 2 and each RA is methyl.
  • R is independently selected from the group consisting of -(C 1 -C 6 )alkyl, -(Co-C6)alkylene-heterocycloalkyl, -(Co-C 6 )alkylene-aryl, and -(C 0 - C 6 )alkylene-heteroaryl and each -(C 1 -C 6 )alkyl, -heterocycloalkyl, -aryl, and - heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -(C 1 -C 6 )alkyl.
  • Rio is selected from the group consisting of: H and - (Ci-C 6 )alkyl optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, and -0-( Ci-C 6 )alkyl.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith-Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by Structural Formula V:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith-Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or CR 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -Cio)heteroaryl, wherein each -(C]-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(C,-C 4 )alkyl, -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, or -COO-R4, wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(C 1 -C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR 5 Rs;
  • ring A is -(C 6 -C ]0 )aryl or -(C 5 -Ci 0 )heteroaryl;
  • each R A is independently H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -C 10 )aryl, or -(C 5 -Ci 0 )heteroaryl, wherein each -(C]-C )alkyl, - (C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C6-Cio)aryl, and -(C 5 -Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two R A together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • Ri is -(CH 2 ) n -L, in which n is 0-3 and L is H, -C(0)0-R 9 , -CO- N(R 9 R,o), -NR 9 R 10 , -N(R,o)C(0)OR 9 , or -N(R 10 )C(O)R 9 ;
  • R 2 is H, D, halogen, or -(d-C 4 )alkyl
  • R4, R 5 , and R 6 are each independently selected from the group consisting of: H, -(C,-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -C 10 )aryl, and -(C 5 -C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 - C 7 )heterocycloalkyl, -(C 6 -C 1 o)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R 10 is selected from the group consisting of: H, -(Ci-C 6 )alkyl, -(C 0 - C6)alkylene-cycloalkyl, -(Co-C6)alkylene-heterocycloalkyl, -(Co-C6)alkylene-aryl; and -(Co-C 6 )alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(Co-C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each - cycloalkyl, -heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • Rg and Rio are taken together with the nitrogen atom to which they are bound form a 4-10-membered ring;
  • Rn is H, -(C,-C 4 )alkyl, or -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, wherein each -(Ci-C 4 )alkyl, and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally and independently substituted with 1 to 3 substituents selected from the group consisting of: -F, -CI, -Br, and -OH;
  • R is H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, - (C 6 -C 1 o)aryl, or -(C5-C 7 )heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents; and
  • m is 0, 1 , 2, or 3.
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • RB is selected from the group consisting of: H, -(Ci-C 4 ) alkyl, and -(d-C 4 )alkylene-0-(Ci-C 4 )alkyl, and each -(Ci-C 4 ) alkyl and -(Ci-C 4 )alkylene- 0-(C 1 -C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -OH.
  • RB is methyl, ethyl, hydroxy methyl, methoxymethyl, or trifluoromethyl.
  • ring A is 5- or 6-membered aryl or heteroaryl.
  • ring A is thiofuranyl, phenyl, naphthyl, biphenyl,
  • ring A is phenyl or thienyl.
  • RA is independently H or -(C 1 -C 4 )alkyl, or any two RA together with the atoms to which each is attached, can form a fused aryl.
  • m is 2, and at least one occurrence of RA is methyl.
  • m is 2 and each RA is methyl.
  • L is -CO-N(R 9 Rio)
  • R 9 is -(Co-C 6 )alkylene-heterocycloalkyl, - (Co-C 6 ) alkylene-aryl, or -(C 0 -C6)alkylene-heteroaryl, optionally and independently substituted with 1 to 4 (Ci-C 4 )alkyl
  • Rio is H or -(Ci-C 6 )alkyl.
  • L is -COO-R 9
  • R 9 is independently selected from the group consisting of -(Ci-C 6 )alkyl, -(Co-C6)alkylene-heterocycloalkyl, -(Co- C 6 )alkylene-aryl, and -(Co-C6)alkylene-heteroaryl and each -(Ci-C 6 )alkyl, - heterocycloalkyl, -aryl, and -heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and - (Ci-C 6 )alkyl.
  • L is -COO-R 9
  • R 9 is selected from the group consisting of: methyl, ethyl, propyl, i-propyl, butyl, sec-butyl, t-butyl, and trifluoromethyl.
  • R 2 is H or -(Ci-C 4 )alkyl.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia ⁇ e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented b Structural Formula VI:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • X is N or C 3 ;
  • R 3 is selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C 3 - C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 1 o)heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C5-Cio)heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R B is H, -(Ci-C 4 )alkyl, -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl, or -COO-R ⁇ wherein each -(Ci-C 4 )alkyl and -(Ci-C 4 )alkylene-0-(C 1 -C 4 )alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, -OH, and -NR 5 R 6 ;
  • each R A is independently H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -Cio)aryl, or -(C 5 -Cio)heteroaryl, wherein each -(C 1 -C 4 )alkyl, - (C 3 -C 8 )cycloalkyl, -(C 5 -C 7 ) heterocycloalkyl, -(C 6 -Cio)aryl, and -(Cs-C ⁇ heteroaryl is optionally and independently substituted with 1 to 4 substituents; or any two RA together with the atoms to which each is bound form a fused aryl or heteroaryl group;
  • L is H, -C(0)0-R 9 , -CO-N(R 9 Ri 0 ), -NR 9 Ri 0 , -N(R 10 )C(O)OR 9 , or - N(R,o)C(0)R 9 ;
  • Rc is selected from the group consisting of: -F, -CI, -Br, -OH, -0-(C C 4 )alkyl, -(CrC ⁇ alkylene-O-f i-C ⁇ alkyl, halo-substituted- ⁇ -C 4 )alkyl, halo- substituted-0-(Ci-C 4 )alkyl, -C(0)-(C r C 4 )alkyl, -C(0)-(fluoro-substituted-(C 1 - C 4 )alkyl), -S(O) 0 -(Ci-C 4 )alkyl, -NR 7 R 8 and CN;
  • R4, R 5 , R6, R 7 and R 8 are each independently selected from the group consisting of: H, -(Ci-C 4 )alkyl, -(C3-C 8 )cycloalkyl, -(C5-C 7 )heterocycloalkyl, -(C 6 - Cio)aryl, and -(C 5 -C7)heteroaryl, wherein each -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, - (C5-Cv)heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • Rio is selected from the group consisting of: H, -(Ci-Ce)alkyl, -(C 0 - C 6 )alkylene-cycloalkyl, -(Co-C6)alkylene-heterocycloalkyl, -(Co-C6)alkylene-aryl; and -(Co-C 6 )alkylene-heteroaryl, wherein each -(Ci-C 6 )alkyl and -(Co-C 6 )alkylene- is optionally and independently substituted with 1 to 4 substituents and each - cycloalkyl, -heterocycloalkyl, -aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • R9 and Rio are taken together with the nitrogen atom to which they are bound form a 4- 10-membered ring;
  • Ri 1 is H, -(Ci-C 4 )alkyl, or -(C,-C 4 )alkylene-0-(Ci-C 4 )alkyl, wherein each -(Ci-C 4 )alkyl, and -(Ci-C 4 )alkylene-0-(Ci-C 4 )alkyl is optionally and independently substituted with 1 to 3 substituents selected from the group consisting of: -F, -CI, -Br, and -OH;
  • Ri2 is H, -(Ci-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, - (C6-Cio)aryl, or -(C5-C 7 )heteroaryl, wherein each -(C]-C 4 )alkyl, -(C 3 -C 8 )cycloalkyl, -(C 5 -C 7 )heterocycloalkyl, -(C 6 -Cio)aryl, and -(C 5 -C 7 )heteroaryl is optionally and independently substituted with 1 to 4 substituents;
  • m is 0, 1, 2, or 3;
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • RB is selected from the group consisting of: H, -(C1-C ) alkyl, and -(C 1 -C4)alkylene-0-(C 1 -C4)alkyl, and each -(C1-C4) alkyl and -(Ci-C4)alkylene- 0-(Ci-C4)alkyl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -OH.
  • RB is methyl, ethyl, hydroxy methyl, methoxymethyl, or trifluoromethyl.
  • each RA is independently H or -(Cj-C4)alkyl, or any two RA together with the atoms to which each is attached, can form a fused aryl.
  • m is 1 or 2
  • at least one occurrence of RA is methyl
  • m is 2 and each RA is methyl.
  • L is -CO-N(R9Ri 0 ), R9 is -(C 0 -C 6 )alkylene-heterocycloalkyl, - (C 0 -C 6 ) alkylene-aryl, or -(C 0 -C6)alkylene-heteroaryl and each -heterocycloalkyl, - aryl, and -heteroaryl is optionally and independently substituted with 1 to 4 (Cj- C 4 )alkyl, and R l0 is H or -(C 1 -C 6 )alkyl.
  • L is -COO-R9
  • R9 is independently selected from the group consisting of -(Ci-C 6 )alkyl, -(C 0 -C6)alkylene -heterocycloalkyl, -(C 0 - C 6 )alkylene-aryl, and -(C 0 -C 6 )alkylene-heteroaryl and each -(C 1 -C 6 )alkyl, - heterocycloalkyl, -aryl, and -heteroaryl is optionally substituted with 1 to 4 substituents independently selected from the group consisting of -F, -CI, -Br, and -
  • L is -COO-R9
  • R9 is selected from the group consisting of: methyl, ethyl, propyl, i-propyl, butyl, sec-butyl, t-butyl, and trifluoromethyl.
  • Rc is selected from the group consisting of: -F, -CI, -Br, -OH, and -0-(Ci-C 4 )alkyl.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia ⁇ e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by invention provides a method for treating insulinoma or congenital hyperinsulinism (CHI) in a subject in need thereof using a compound represented following structural formula:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • PCOS polycystic ovary syndrome
  • CHI congenital hyperinsulinism
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the compound is represented following structural formula: or a pharmaceutically acceptable salt thereof.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia ⁇ e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia ⁇ e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by represented by any one of the following structural formulas:
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by the structure:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, coneential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound re resented by the structure:
  • a condition associated with hyperinsulinaemia e.g., insulinoma, coneential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprisin unt of a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprisin unt of a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprisin unt of a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, poly
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by Structural Formula (VI), (VII), or (VIII):
  • R, Rj , and R 2 and RB have the same meaning as in Formula (I); Y is O, N, S, or CR 3 , in which R 3 has the same meaning as in Formula (I); n is 0 or 1 ; and the dashed circle in Formula (VIII) indicates an aromatic or non-aromatic ring; or a pharmaceutically acceptable salt thereof.
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the present invention is directed to a method for treating a condition associated with hyperinsulinaemia ⁇ e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof, comprising administering to the subject an effective amount of a compound represented by the structure:
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • the compound for use in the methods of the invention is a compound selected from the group consisting of :
  • hyperinsulinaemia is an insulinoma.
  • hyperinsulinaemia is congenital hyperinsulinism.
  • Scheme 2 provides additional exemplary synthetic schemes for preparing further compounds of the invention
  • Scheme 2 [00349] As shown in Scheme 2, a fused bicyclic precursor (see Scheme SI , infra, for synthesis of this compound) can be treated with dimethylaminomethylene bromide (DAM-Br) to obtain the DAM-protected intermediate shown in Scheme 2. Reaction of the DAM-protected intermediate with a hydrazine yields the tricyclic fused core. Substituent R x can be varied by selection of a suitable hydrazine.
  • DAM-Br dimethylaminomethylene bromide
  • Amides can be prepared from the carboxylic acid or ester. Amidation of the carboxylic acid with an appropriate amine using standard amidation (e.g., coupling condtion) conditions provides the amide product. In certain embodiments, the amide product formed is an amide substituted with a heterocycle connected by a two-carbon "linker". Exemplary amide structures include:
  • the amide product formed is an amide substituted with a heterocycle connected by a three-carbon "linker”. In certain embodiments, the amide product formed is an amide substituted with a heterocycle connected by a one-carbon "linker”.
  • Another aspect of the present invention is a method for reducing the growth, proliferation, and survival of an insulinoma cell, the method comprising contacting the cell with a compound disclosed herein, or a pharmaceutically acceptable salt thereof.
  • the method for reducing the growth, proliferation and survival of an insulinoma cell further comprises selecting the compound for binding to a bromodomain of the BET family.
  • the BET family member is BRD2, BRD3, BRD4 or BRDT.
  • Another aspect of the present invention is a method of inducing cell death in an insulinoma cell, the method comprising contacting the cell with a compound disclosed herein, or a pharmaceutically acceptable salt thereof.
  • the method of inducing cell death in an insulinoma cell further comprises selecting the compound for binding to a bromodomain of the BET family.
  • the BET family member is BRD2, BRD3, BRD4 or BRDT.
  • the subject is a mammal. In another embodiment, the subject is a human.
  • Another aspect of the present invention is a method for treating insulinoma in a subject in need thereof, the method comprising administering an effective amount of a compound disclosed herein, or a pharmaceutically acceptable salt thereof, wherein said compound is capable of binding a BET family
  • bromodomain and disrupting bromodomain interaction with chromatin thereby treating cancer.
  • Insulin secretion in insulinomas is not regulated by glucose and the tumors will continue to secrete insulin and cause glucose levels to fall below normal.
  • Medications such as diazoxide and somatostatin, can also be utilized to lower insulin levels in patients who are not surgical candidates or who have otherwise inoperable tumors or for patients having other hyperinsulinaemic disorders. As such, effective therapies are limited.
  • CHI congenital hyperinsulism
  • CHI congenital hyperinsulism
  • the genetic disorders can be caused by mutations in genes that regulate the release of insulin or in other genes involved in glucose regulation.
  • CHI idiopathic hypoglycemis of infancy, nesidioblastosis, persistent hyperinsulinemic hypoglycemia of infancy, PHHI.
  • Current treatement of CHI include administration of glucagon, somatostatin analogues, diazoxide and near-total pancreatectomy. Glucagon is not appropriate as a long-term treatment, and somatostatin analogs and diazoxide have been associated with severe adverse effects.
  • “Pharmaceutically acceptable carrier” and “pharmaceutically acceptable diluent” means non-therapeutic components that are of sufficient purity and quality for use in the formulation of a composition of the invention that, when appropriately administered to an animal or human, typically do not produce an adverse reaction, and that are used as a vehicle for a drug substance (i.e. , a compound of the present invention).
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS),
  • PCOS polycystic ovary syndrome
  • pharmaceutically acceptable salt also refers to a salt prepared from a compound disclosed herein, or any other compound delineated herein having a basic functional group, such as an amino functional group, and a pharmaceutically acceptable inorganic or organic acid.
  • a basic functional group such as an amino functional group
  • an acid salt of a compound of the present invention containing an amine or other basic group can be obtained by reacting the compound with a suitable organic or inorganic acid, resulting in pharmaceutically acceptable anionic salt forms.
  • anionic salts include the acetate, benzenesulfonate, benzoate, bicarbonate, bitartrate, bromide, calcium edetate, camsylate, carbonate, chloride, citrate, dihydrochloride, edetate, edisylate, estolate, esylate, fumarate, glyceptate, gluconate, glutamate, glycollylarsanilate, hexylresorcinate, hydrobromide, hydrochloride, hydroxynaphthoate, iodide, isethionate, lactate, lactobionate, malate, maleate, mandelate, mesylate, methylsulfate, mucate, napsylate, nitrate, pamoate, pantothenate, phosphate/diphosphate, polygalacturonate, salicylate, stearate, subacetate, succinate, sulfate, tannate,
  • pharmaceutically acceptable salt also refers to a salt prepared from a compound disclosed herein or any other compound delineated herein, having an acidic functional group, such as a carboxylic acid functional group, and a pharmaceutically acceptable inorganic or organic base.
  • Salts of the compounds used in the methods of the present invention containing a carboxylic acid or other acidic functional group can be prepared by reacting with a suitable base.
  • a suitable base which affords a pharmaceutically acceptable cation, which includes alkali metal salts (especially sodium and potassium), alkaline earth metal salts (especially calcium and magnesium), aluminum salts and ammonium salts, as well as salts made from physiologically acceptable organic bases such as trimethylamine, triethylamine, morpholine, pyridine, piperidine, picoline, dicyclohexylamine, ⁇ , ⁇ '- dibenzylethylenediamine, 2-hydroxyethylamine, bis-(2-hydroxyethyl)amine, tri-(2- hydroxyethyl)amine, procaine, dibenzylpiperidine, dehydroabietylamine, ⁇ , ⁇ '- bisdehydroabietylamine, glucamine, N-methylglucamine,
  • alkali metal salts especially sodium and potassium
  • the invention also includes treatment of a condition associated with hyperinsulinaemia (e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) in a subject in need thereof with various isomers and mixtures thereof.
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • a condition associated with hyperinsulinaemia e.g., insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • Certain compounds for the treatment of insulinomas or congential hyperinsulism of the present invention may exist in various stereoisomeric forms. Stereoisomers are compounds which differ only in their spatial arrangement.
  • Enantiomers are pairs of stereoisomers whose mirror images are not superimposable, most commonly because they contain an asymmetrically substituted carbon atom that acts as a chiral center. "Enantiomers” means one of a pair of molecules that are mirror images of each other and are not superimposable. Diastereomers are stereoisomers that are not related as mirror images, most commonly because they contain two or more asymmetrically substituted carbon atoms, "i?” and "5" represent the configuration of substituents around one or more chiral carbon atoms. When a chiral center is not defined as R or S, either a pure enantiomer or a mixture of both configurations is present.
  • Racemate or “racemic mixture” means a compound of equimolar quantities of two enantiomers, wherein such mixtures exhibit no optical activity (i.e., they do not rotate the plane of polarized light).
  • the compounds used in the methods of the present invention may be prepared as individual isomers by either isomer-specific synthesis or resolved from an isomeric mixture.
  • Conventional resolution techniques include forming the salt of a free base of each isomer of an isomeric pair using an optically active acid
  • the stereochemistry of a disclosed compound is named or depicted by structure
  • the named or depicted stereoisomer is at least 60%, 70%, 80%, 90%, 99% or 99.9% by weight pure relative to the other stereoisomers.
  • the depicted or named enantiomer is at least 60%, 70%, 80%, 90%, 99% or 99.9% by weight optically pure. Percent optical purity by weight is the ratio of the weight of the enantiomer that is present divided by the combined weight of the enantiomer that is present and the weight of its optical isomer.
  • tautomers refers to isomers of organic molecules that readily interconvert by tautomerization, in which a hydrogen atom or proton migrates in the reaction, accompanied in some occasions by a switch of a single bond and an adjacent double bond.
  • subject refers to animals such as mammals, including, but not limited to, primates ⁇ e.g., humans), cows, sheep, goates, horses, pigs, dogs, cats, rabbits, guinea pigs, rates, mice or other bovine, ovine, equine, canine, feline, rodent or murine species.
  • hyperinsulinaemia is characterized by levels of insulin circulating in the blood that are in excess of those expected relative to the level of glucose. Hyperinsulinaemia is a result of unregulated insulin secretion by beta cells of the pancreas despite low blood glucose levels.
  • Hyperinsulinaemia is associated with a variety of conditions such as insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and can occur in patients following gastric bypass surgery.
  • Treatment of diseases or disorders associated with hyperinsulinaemia can include lessening the severity of the disease or disorder or improving the symptoms associated with the disease or disorder.
  • treatment at least includes reduction of insulin secretion.
  • treatment at least includes reduction of insulin secretion to levels in the blood that are not in excess of those expected relative to the level of glucose.
  • treatment includes reduction of the tumor volume of the insulinoma, reduction of secretion of insulin or a combination thereof.
  • a "condition associated with hyperinsulinaemia" means a condition in which levels of insulin circulating in the blood are in excess of those expected relative to the level of glucose.
  • Conditions associated with hyperinsulinaemia are a result of unregulated insulin secretion by beta cells of the pancreas despite low blood glucose levels.
  • Conditions associated with hyperinsulinaemia include, but are not limited to, insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and can occur in patients following gastric bypass surgery.
  • PCOS polycystic ovary syndrome
  • an effective amount refers to an amount which, when administered in a proper dosing regimen, is sufficient to treat (therapeutically or prophylactically) the target condition, in this case, a condition associated with hyperinsulinaemia ⁇ e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery).
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery.
  • an effective amount is sufficient to reduce or ameliorate the severity, duration, or progression of the disorder being treated, prevent the advancement of the disorder being treated, cause the regression of the disorder being treated, or enhance or improve the prophylactic or therapeutic effect(s) of another therapy.
  • an effective amount can be an amount that reduces tumor volume of the insulinoma, reduces secretion of insulin or
  • An effective amount may contain from about .001 mg/kg/day to about 1000 mg/kg/day. In one embodiment, the effective amount of a compound of the invention is from about 0.001 mg/kg/day to about 100 mg/kg/day. In another embodiment, the effective amount of a compound of the invention is from about 0.01 mg/kg/day to about 50 mg/kg/day. In yet another embodiment, the effective amount of a compound of the invention is from about 0.01 mg/kg/day to about 25 mg/kg/day. In yet another embodiment, the effective amount of a compound of the invention is from about 0.02 mg/kg/day to about 10 mg/kg/day. In yet another embodiment, the effective amount of a compound of the invention is from about 0.03 mg/kg/day to about 6 mg/kg/day, such as from about about 0.03 mg/kg/day to about 3 mg/kg/day. Mode of Administration
  • compositions used in the methods of the present invention include ocular, oral, nasal, transdermal, topical with or without occlusion, intravenous (both bolus and infusion), inhalable, and injection (intraperitoneally, subcutaneously, intramuscularly, intratumorally, or parenterally) formulations.
  • the compositions are for intravenous or oral administration.
  • the composition may be in a dosage unit such as a tablet, pill, capsule, powder, granule, liposome, ion exchange resin, sterile ocular solution, or ocular delivery device (such as a contact lens and the like facilitating immediate release, timed release, or sustained release), parenteral solution or suspension, metered aerosol or liquid spray, drop, ampoule, auto-injector device, or suppository; for administration ocularly, orally, intranasally, sublingually, parenterally, or rectally, or by inhalation or insufflation.
  • a dosage unit such as a tablet, pill, capsule, powder, granule, liposome, ion exchange resin, sterile ocular solution, or ocular delivery device (such as a contact lens and the like facilitating immediate release, timed release, or sustained release), parenteral solution or suspension, metered aerosol or liquid spray, drop, ampoule, auto-injector device, or suppository; for administration
  • compositions used in the methods of the invention suitable for oral administration include solid forms such as pills, tablets, caplets, capsules (each including immediate release, timed release, and sustained release formulations), granules and powders; and, liquid forms such as solutions, syrups, elixirs, emulsions, and suspensions.
  • forms useful for ocular administration include sterile solutions or ocular delivery devices.
  • forms useful for parenteral administration include sterile solutions, emulsions, and suspensions.
  • compositions used in the methods of the invention may be administered in a form suitable for once- weekly or once-monthly administration.
  • an insoluble salt of the active compound may be adapted to provide a depot preparation for intramuscular injection ⁇ e.g., a decanoate salt) or to provide a solution for ophthalmic administration.
  • the dosage form containing the composition used in the methods of the invention contains an effective amount of the active ingredient necessary to provide a therapeutic effect.
  • the composition may contain from about 5,000 mg to about 0.01 mg of a compound of the invention, or pharmaceutically acceptable salt thereof, and may be constituted into any form suitable for the selected mode of
  • the composition comprises about 5000 mg to about 0.01 mg of a compound of the invention, or pharmaceutically acceptable salt thereof. In another embodiment, the composition comprises about 1000 mg to about 0.01 mg of a compound of the invention, or pharmaceutically acceptable salt thereof. In yet another embodiment, the composition comprises about 100 mg to about 0.01 mg of a compound of the invention, or pharmaceutically acceptable salt thereof.
  • the composition may be administered about 1 to about 5 times per day. Daily administration or periodic dosing may be employed.
  • the composition is preferably in the form of a tablet or capsule containing (e.g. , 1000 to 0.5 milligrams of the active compound). Dosages will vary depending on factors associated with the particular patient being treated (e.g. , age, weight, diet, and time of administration), the severity of the condition being treated, the compound being employed, the mode of administration, and the strength of the preparation.
  • the oral composition is preferably formulated as a homogeneous composition, wherein the active ingredient is dispersed evenly throughout the mixture, which may be readily subdivided into dosage units containing equal amounts of a compound of the invention.
  • the compositions are prepared by mixing a compound of the invention (or pharmaceutically acceptable salt thereof) with one or more optionally present pharmaceutical carriers (such as a starch, sugar, diluent, granulating agent, lubricant, glidant, binding agent, and disintegrating agent), one or more optionally present inert pharmaceutical excipients (such as water, glycols, oils, alcohols, flavoring agents, preservatives, coloring agents, and syrup), one or more optionally present conventional tableting ingredients (such as corn starch, lactose, sucrose, sorbitol, talc, stearic acid, magnesium stearate, dicalcium phosphate, and any of a variety of gums), and an optional diluent (such as water).
  • pharmaceutical carriers such as a
  • Binder agents include starch, gelatin, natural sugars (e.g., glucose and beta-lactose), corn sweeteners and natural and synthetic gums (e.g., acacia and tragacanth).
  • Disintegrating agents include starch, methyl cellulose, agar, and bentonite.
  • Tablets and capsules represent an advantageous oral dosage unit form.
  • Tablets may be sugarcoated or filmcoated using standard techniques. Tablets may also be coated or otherwise compounded to provide a prolonged, control-release therapeutic effect.
  • the dosage form may comprise an inner dosage and an outer dosage component, wherein the outer component is in the form of an envelope over the inner component.
  • the two components may further be separated by a layer which resists disintegration in the stomach (such as an enteric layer) and permits the inner component to pass intact into the duodenum or a layer which delays or sustains release.
  • enteric and non-enteric layer or coating materials such as polymeric acids, shellacs, acetyl alcohol, and cellulose acetate, or combinations thereof may be used.
  • compositions include a compound of the invention and a biodegradable slow release carrier (e.g. , a polymeric carrier) or a pharmaceutically acceptable non-biodegradable slow release carrier (e.g. , an ion exchange carrier).
  • a biodegradable slow release carrier e.g. , a polymeric carrier
  • a pharmaceutically acceptable non-biodegradable slow release carrier e.g. , an ion exchange carrier
  • Biodegradable and non-biodegradable slow release carriers are well known in the art.
  • Biodegradable carriers are used to form particles or matrices which retain an active agent(s) and which slowly degrade/dissolve in a suitable environment (e.g. , aqueous, acidic, basic and the like) to release the agent.
  • a suitable environment e.g. , aqueous, acidic, basic and the like
  • Such particles degrade/dissolve in body fluids to release the active compound(s) therein.
  • the particles are preferably nanoparticles or nanoemulsions (e.g. , in the range of about 1 to 500 nm in diameter, preferably about 50-200 nm in diameter, and most preferably about 100 nm in diameter).
  • a slow release carrier and a compound of the invention are first dissolved or dispersed in an organic solvent.
  • the resulting mixture is added into an aqueous solution containing an optional surface-active agent(s) to produce an emulsion.
  • the organic solvent is then evaporated from the emulsion to provide a colloidal suspension of particles containing the slow release carrier and the compound of the invention.
  • the compound disclosed herein and used in the methods of the invention may be incorporated for administration orally or by injection in a liquid form such as aqueous solutions, suitably flavored syrups, aqueous or oil suspensions, flavored emulsions with edible oils such as cottonseed oil, sesame oil, coconut oil or peanut oil and the like, or in elixirs or similar pharmaceutical vehicles.
  • aqueous solutions suitably flavored syrups, aqueous or oil suspensions, flavored emulsions with edible oils such as cottonseed oil, sesame oil, coconut oil or peanut oil and the like, or in elixirs or similar pharmaceutical vehicles.
  • Suitable dispersing or suspending agents for aqueous suspensions include synthetic and natural gums such as tragacanth, acacia, alginate, dextran, sodium carboxymethylcellulose, methylcellulose, polyvinyl-pyrrolidone, and gelatin.
  • liquid forms in suitably flavored suspending or dispersing agents may also include synthetic and natural gums.
  • sterile suspensions and solutions are desired.
  • Isotonic preparations, which generally contain suitable preservatives, are employed when intravenous administration is desired.
  • the compound, or a pharmaceutically acceptable salt thereof is administered orally.
  • the compound, or a pharmaceutically acceptable salt thereof is administered intravenously.
  • the compounds used in the methods may be
  • a parenteral formulation may consist of the active ingredient dissolved in or mixed with an appropriate inert liquid carrier.
  • Acceptable liquid carriers usually comprise aqueous solvents and other optional ingredients for aiding solubility or preservation.
  • aqueous solvents include sterile water, Ringer's solution, or an isotonic aqueous saline solution.
  • Other optional ingredients include vegetable oils (such as peanut oil, cottonseed oil, and sesame oil), and organic solvents (such as solketal, glycerol, and formyl).
  • a sterile, non-volatile oil may be employed as a solvent or suspending agent.
  • the parenteral formulation is prepared by dissolving or suspending the active ingredient in the liquid carrier whereby the final dosage unit can contain from about 0.005 to about 99% by weight of the active ingredient.
  • Other additives include preservatives, isotonizers, solubilizers, stabilizers, and pain-soothing agents.
  • Injectable suspensions may also be prepared, in which case appropriate liquid carriers, suspending agents and the like may be employed.
  • Compounds used in the methods of the invention may be administered intranasally using a suitable intranasal vehicle.
  • the compounds used in the methods of this invention may be administered directly to the lungs by inhalation.
  • compositions used in the methods of the invention may also be administered topically or enhanced by using a suitable topical transdermal vehicle or a transdermal patch.
  • the composition is preferably in the form of an ophthalmic composition.
  • the ophthalmic compositions are preferably formulated as eye-drop formulations and filled in appropriate containers to facilitate administration to the eye, for example a dropper fitted with a suitable pipette.
  • the compositions are sterile and aqueous based, using purified water.
  • an ophthalmic composition may contain one or more of: a) a surfactant such as a polyoxyethylene fatty acid ester; b) a thickening agents such as cellulose, cellulose derivatives, carboxyvinyl polymers, polyvinyl polymers, and polyvinylpyrrolidones, typically at a concentration n the range of about 0.05 to about 5.0% (wt/vol); c) (as an alternative to or in addition to storing the
  • the pH of the ophthalmic composition is desirably within the range of 4 to 8.
  • the methods of the present invention also include treatment of a condition associated with hyperinsulinaemia (e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery) using a compound of the invention, or a pharmaceutically acceptable salt thereof, alone or in combination with one or more therapeutic agents, or a pharmaceutically acceptable salt thereof.
  • a condition associated with hyperinsulinaemia e.g. , insulinoma, congential hyperinsulism, polycystic ovary syndrome (PCOS), Beckwith- Wiedemann syndrome and in patients following gastric bypass surgery
  • a compound of the invention or a pharmaceutically acceptable salt thereof, alone or in combination with one or more therapeutic agents, or a pharmaceutically acceptable salt thereof.
  • the one or more therapeutic agent can be, for example, any agent that is capable of treating insulinomas.
  • the one or more therapeutic agent can be any agent known in the art to treat cancer, any agent that is an insulin secretion inhibiting agent, or any agent of benefit to the patient when administered in combination with a compound of the invention.
  • therapeutic agents known in the art to treat cancer and suitable for use in combination with the compounds of the invention include, but are not limited to, CdK.4/6 inhibitors (e.g. , PD0332992(palbociclib)), 5-fluorouracil, 6-mercaptopurine, capecitabine, cladribine, clofarabine, cytarabine, floxuridine, fludarabin, gemcitabine,
  • hydroxyurea methotrexate, pemetrexed, pentostatin, thioguanine, daunorubicin, doxorubicin, epirubicin, idarubicin, actinomycin-D, bleomycin, mitomycin-C, topotecan, irinotecan, etoposide, teniposide, mitoxantrone, paclitaxel, docetaxel, ixabepilone, vinblastine, vincristine, vinorelbine, estramustine, prednisone, methylprednisolone, dexamethasone, mechlorethamine, chlorambucil,
  • insulin secretion inhibiting agents include, but are not limited to, diazoxide, somatostatin, octreotide, and nifedipine.
  • the one or more therapeutic agents do not diminish the effects of the therapy the effects of the primary administration.
  • the methods of the present invention also include treatment of congential hyperinsulism using a compound of the invention, or a pharmaceutically acceptable salt thereof, alone or in combination with one or more therapeutic agents, or a pharmaceutically acceptable salt thereof.
  • the one or more therapeutic agent can be any agent that is capable of treating congential
  • the one or more therapeutic agent can be any agent known in the art that is an insulin secretion inhibiting agent, or any agent of benefit to the patient when administered in combination with a compound of the invention.
  • insulin secretion inhibiting agents include, but are not limited to, diazoxide, somatostatin, octreotide, and nifedipine.
  • the one or more therapeutic agents do not diminish the effects of the therapy the effects of the primary administration.
  • the combination therapy comprises a compound of the invention, or a pharmaceutically acceptable salt thereof, and a therapeutic agent known in the art to treat cancer, or a pharmaceutically acceptable salt thereof and the disorder associated with hyperinsulinaemia is an insulinoma.
  • the combination therapy comprises a compound of the invention, or a pharmaceutically acceptable salt thereof, and an insulin secretion inhibiting agent, or a pharmaceutically acceptable salt thereof.
  • the combination therapy comprises a compound of the invention, or a pharmaceutically acceptable salt thereof, a therapeutic agent known in the art to treat cancer, or a pharmaceutically acceptable salt thereof, and an insulin secretion inhibiting agent, or a pharmaceutically acceptable salt thereof and the condition associated with hyperinsulinaemia is an insulinoma.
  • the combination therapy comprises a compound of the invention, or a pharmaceutically acceptable salt thereof, and an agent that is capable of treating congential hyperinsulism, or a pharmaceutically acceptable salt thereof.
  • the combination therapy comprises a compound of the invention, or a pharmaceutically acceptable salt thereof, an agent that is capable of treating congential hyperinsulism, or a pharmaceutically acceptable salt thereof, and an insulin secretion inhibiting agent, or a pharmaceutically acceptable salt thereof.
  • combination with refers to the co-administration of a first amount of a compound capable of treating a disorder associated with hyperinsulinaemia, or a pharmaceutically acceptable salt thereof, and a second amount of at least one therapeutic agent, or a pharmaceutically acceptable salt thereof, wherein the first and second amounts together comprise a therapeutically effective amount to treat a disorder associated with
  • Combination therapy encompasses administration of the first and second amounts of the compounds of the coadministration in an essentially simultaneous manner, such as in a single pharmaceutical composition, for example, capsule or tablet having a fixed ratio of first and second amounts, or in multiple, separate capsules or tablets for each.
  • co-administration also encompasses use of each compound in a sequential manner in either order.
  • co-administration involves the separate administration of the first amount of the compound capable of treating a disorder associated with hyperinsulinaemia, or a pharmaceutically acceptable salt thereof, and a second amount of at least one therapeutic agent, or a pharmaceutically acceptable salt thereof, the compounds are administered sufficiently close in time to have the desired therapeutic effect.
  • the period of time between each administration can range from minutes to hours and can be determined taking into account the properties of each compound such as potency, solubility, bioavailability, plasma half-life and kinetic profile.
  • pharmaceutically acceptable salt thereof, and at least one therapeutic agent, or a pharmaceutically acceptable salt thereof can be administered in any order within about 24 hours of each other, within about 16 hours of each other, within about 8 hours of each other, within about 4 hours of each other, within about 1 hour of each other or within about 30 minutes of each other.
  • HCTU (2-(6-chloro- 1 H-benzotriazole- 1 -yl)- 1,1 ,3,3- tetramethylaminium hexafluorophosphate
  • High resolution mass spectra were recorded on a Bruker APEX 4.7 Tesler FTMS spectrometer using electrospray ion source (ESI) at the Instrumentation Facility of the Department of Chemistry, Massachusetts Institute of Technology.
  • the intermediates and final product were purified with a CombiFlash RF system (Teledyne Isco). Organic solutions were concentrated on Buchi R-205 rotary evaporators.
  • the enantiomeric purities were checked with Berger Supercritical Fluid Chromatography (SFC) and an AS-H column.
  • the enantiomeric preparative purification was performed with Agilent High Pressure Liquid Chromatography and an OD-H column (Broad Institute of Harvard and MIT). cheme SI. Synthesis of the racemic bromodomain inhibitor ( ⁇ )-JQl.
  • Amino ketone (S4) (280 mg, 0.63 mmol) was dissolved in 10 % acetic acid ethanol solution (21 ml, 0.03 M). The reaction mixture was heated to 85 °C. After 30 minutes, all solvents were removed under reduced pressure. The residue was purified by flash column chromatography (Combiflash RF system, 12 gram silica gel, gradient 0 to 100 % ethyl acetate-hexanes) to afford compound S5 (241 mg, 95 %) as white solid. Enantiomeric purity of S5 was 67 % (determined with Berger Supercritical Fluid Chromatography (SFC) using an AS-H column).
  • SFC Berger Supercritical Fluid Chromatography
  • Acetic hydrazide (30 mg, 0.40 mmol, 1.50 equiv) was added to reaction mixture. The reaction mixture was stirred at 23 °C. After 1 h, 1-butanol (2.25 ml) was added to reaction mixture, which was heated to 90 °C. After 1 h, all solvents were removed under reduce pressure.
  • Table A below shows the additional compounds prepared for use in the methods of the present invention.
  • the binding activity of lead compounds with the BRD4 site 1 was determined by Alpha-assay with a 12-point dose response curve.
  • Compound (S)- JQ1 (JQS) was used as a positive control.
  • (R)-JQ1 (JQ-R) was used as a negative control.
  • Compounds (S)-JQ6, (S)-JQ8, (S)-JQ13, (S)-JQ33 and (S)-JQ35 exhibited excellent binding activity.
  • the results of binding activity of all lead compounds with the BRD4 site 2 was also determined by Alpha-assay with a 12-point dose response curve.
  • Compounds (S)-JQ6, (S)-JQ8, (S)-JQ13, (S)-JQ33 and (S)-JQ35 exhibited excellent binding activity.
  • the activity of the lead compounds was examined in a cell-assay with the 797 cell line (derived from patient) to determine the growth effects of BRD4 inhibition on BRD4-NUTdependent cell lines. Cells were incubated with compounds and monitored for proliferation after 72 hours. Curve fit was calculated by logistical regression. All the lead compounds were examined in cell-assays with 10326 cell line that directly derived from a patient to determine the growth effects of BRD4 inhibition on BRD4-NUT dependent cell lines. Cells were incubated with compounds and monitored for proliferation after 72 hours. Curve fit was calculated by logistical regression.
  • a Cell Titer-Glo assay was utilized to test the sensitivity of four rat insulinoma (RJN) cell lines, RIN-14B, RIN-m5F, RJN-m, and RIN-5, to (S)-JQ1 (Table 1). Paclitaxel was used as a positive control.
  • the concentrations tested for paclitaxel were, 10 ⁇ , 2.5 ⁇ , 0.625 ⁇ , 0.156 ⁇ , 0.0391 ⁇ , 0.00977 ⁇ , 0.00244 ⁇ , 0.000610 ⁇ , 0.000153 ⁇ , and 0.0000381 ⁇ .
  • Duplicate data for RIN-5F was obtained where the test concentrations for paclitaxel were, 1 ⁇ , 0.25 ⁇ , 0.0625 ⁇ , 0.0156 ⁇ , 0.00391 ⁇ , 0.000977 ⁇ , 0.000244 ⁇ , 0.0000610 ⁇ , 0.0000153 ⁇ , and 0.00000381 ⁇ .
  • Cells were seeded at 300,000 cells per well in a 12-well culture plate in a total volume of 1 mL/well and incubated for 24 hours. After 24 hours of incubation, media was removed and 1 mL of growth media with test compounds (DMSO (control), (S)-JQ1 or (S)-JQ35) at a final concentration of 100 nM or 500 nM was added. After 24, 48, or 72 hours of treatment the amount of insulin secreted into the cell culture media was measured by an ELISA assay (Crystal Chemical, Cat # 90060). The number of viable cells was determined at the end of each time point by Trypan Blue exclusion dye. The amount of insulin secreted per cell was calculated.
  • test compounds DMSO (control), (S)-JQ1 or (S)-JQ35
  • BET bromodomain inhibitors decrease the amount of insulin secreted from the rat insulinoma cell line RIN-m5F.
  • the results showed that over time the control treated cells secrete insulin into the cell culture media.
  • the BET bromodomain inhibitor treated cells did not secrete nearly as much insulin as the DMSO treated cells.
  • Results are shown graphically in FIG. 6.
  • RIN-m5F or RIN-m cells were cultured in RPMI with 10% FBS. Cells were seeded at 2,000,000 cells/well in a 6-well plate (about 4 x 10 5 cells/cm 2 ) in a total volume of 2 mL/well. After 24 hours of incubation in a humidified incubator at 37 °C with 5% C ⁇ 3 ⁇ 4 and 95% air, the medium was replaced with 2-3 mL of fresh medium containing 0.1% DMSO, (S)-JQ1 (500 nM) or (S)-JQ35 (500 nM) and incubated for 24 hr. The media was removed and cells were washed twice with 2 mL cold PBS (IX).
  • Cells were solubilized in 250 xL of Qiazol per well for a total of 2 mL and passed through a 23 gauge needle and syringe to break cell clumps. Lyses were stored at -80 °C or in liquid nitrogen.
  • RNA concentrations were quantified and RNA was stored at -80°C.
  • cDNA was generated from 1000 ng of RNA with a Life Tech-RT Kit (Cat. 4304134).
  • a RT-cDNA reaction mixture containing 10 ⁇ of lOx RT buffer, 22 ⁇ of 25mM magnesium chloride (MgCl 2 ), 20 ⁇ of 10 mM Deoxy NTP mix, 5.5 ⁇ of Random hexamer, 2 ⁇ of RNase inhibitor, 2.5 ⁇ Multiscribe RT (501 ⁇ / ⁇ 1), 18 ⁇ of water and 20 ⁇ (1000 ng) of RNA (50 ng/ ⁇ ) (total volume of 100 ⁇ ) was setup.
  • Tubes were placed at 25 °C for 10 minutes, followed by 48 °C for 30 minutes, then 95 °C for 5 minutes and held at 4°C indefinitely.
  • Quantitative PCR was conducted with Ins 1 , Ins 2, Myc, Mycn, Ifg2, Gck, Cdk6, Cdk4, Brd4 (Actb, Gadph and 18sRNA as controls) Taqman Probes (Applied Biosystems), on a QuantStudio-Real Time PCR machine (Life Technologies). A reaction mixture containing 1 ⁇ of 20x Taqman probe, 10 ⁇ of 2x Taqman Master mix (Life Technologies), 5 ⁇ of Rnase free water, 4 ⁇ of cDNA template (total volume 20 ⁇ ) was setup for each qPCR reaction.
  • insulinomas by potentially inhibiting the expression of cell proliferation genes, cell cycle regulators and components of the insulin pathway.
  • hyperinsulinaemia e.g., insulinomas and congenital hyperinsulism
  • hyperinsulinaemia by reducing insulin gene expression levels.
  • a gene specific chromatin immunoprecipitation assay was performed in RJN-m5F cells to determine if Brd4 is directly regulating the insulin gene (Ins2) and c-Myc oncogene (Myc). Untranscribed region 17 (Untr 17) was used as a negative control.
  • Quantitative PCR (qPCR) reactions were carried out in triplicate on specific genomic regions (Ins2 promoter region, Myc promoter region or an untranscribed negative control region) using SYBR Green Supermix (Bio-Rad). The resulting signals were normalized for primer efficiency by carrying out qPCR for each primer pair using Input DNA.
  • Example 7 Chromatin Immunoprecipitation Sequencing (ChlP-seq) ofBRD4 and Histone H3 Lysine 27 Acetylation (H3K27ac) [00504] Chromatin immunoprecipitation assay followed by massively paralleled sequencing (ChlP-Seq) was performed in an insulinoma cell line, RIN-m5F cells, to determine the genomic wide localization of Brd4 and Histone H3 Lysine 27 Acetylation (H3K27ac).
  • ChIP and Input DNA was prepared as described above.
  • Illumina sequencing libraries were prepared from the ChIP and Input DNAs using the Apollo 324 system (WaferGen). After a final PCR amplification step, the resulting DNA libraries were quantified and sequenced on HiSeq 2500. Sequences (50 nucleotide reads, single end) were aligned to the rat genome (rn5) using the BWA algorithm (default settings). Only reads that pass Illumina' s purity filter, align with no more than 2 mismatches, and map uniquely to the genome are used in the subsequent analysis. In addition duplicate reads were removed.
  • the input DNA was utilized to remove false positive peaks.
  • Signal maps and peak locations were used as input data to Active Motifs proprietary analysis program, which creates Excel tables containing detailed information on sample comparison, peak metrics, peak locations and gene annotations.
  • Brd4 The genome wide localization of Brd4 was determined by chromatin immunoprecipitation followed by massively paralleled sequencing (ChlP-Seq) in an insulinoma cell line. Brd4 was shown to occupy 18,875 regions (p-value cutoff of le-7) across the genome (Table C). Of these, 13,009 (68.9%) are found within lOkb +/- of the beginning or end of a gene and 5,035 (26.7%) of the Brd4 occupied sites occurred within the promoter region of genes (500 bp of the transcriptional start site).
  • H3K27ac the genome wide localization of the enhancer mark (H3K27ac) was determined by ChlP-Seq (Table D). 27,756 regions were detected that had H3K27ac (p-value cutoff of le-7). Of the Brd4 occupied regions the majority (88.8%) overlapped with H3K27ac indicating that Brd4 occupies enhancers in insulinoma cells.
  • * ⁇ promoter was considered occupied if Brd4 binding occurred within 500 bp of the transcriptional start site.
  • c-Myc, n-Myc, Cdk6 and Insl gene expression has been shown to decrease in rat insulinoma cell lines when Brd4 function is inhibited with BET bromodomain inhibitors.
  • Example 5 The results of the genome wide localization of Brd4 and H3K27ac indicate that Brd4 occupies both enhancer and promoter regions of oncogenes and insulin pathway genes in insulinoma cells.
  • FIG. 14 shows that Brd4 occupancy occurs at the promoters and enhancer regions (note overlap with H3K27ac) of c-Myc, n-Myc genes, Cdk6, Bcl2, insulin 1 gene (Insl), Abcc8, Kcnj 11, Gck and Igf2.
  • Brd4 occupies the promoters and enhancer regions of Abcc8, Kcnj 1 1, Gck and Igf2 genes which have been linked not only to insulinomas but also other congenital hyperinsulinemia disorders.
  • Super-enhancers are exceptionally large enhancer regions that are occupied by coactivators such as Brd4. Super-enhancers are found at oncogenes across a range of cancer types and at genes that are important for defining the biology of the cell type. Genes that are the most sensitive to BET bromodomain inhibition tend to be regulated by super-enhancers. Identification of super-enhancers allows for the prediction of genes that will be most sensitive to treatment with a BET bromodomain inhibitor. In order to identify potential super-enhancers in insulinoma all Brd4 bound regions were rank ordered by total number of reads (FIG. 15). A small percentage (top 4%) of Brd4-occupied regions contains a large portion of the Brd4 reads (21%).
  • Brd4 occupies both enhancer and promoter regions in insulinoma.
  • Brd4 is found at the promoters, enhancers and potential super-enhancers of both oncogenes and insulin pathway genes, providing a rational for using BET bromodomain inhibitors to lower the expression levels of these genes in both insulinoma and CHI patients.
  • a Cell Titer-Glo assay was utilized to test the sensitivity of four rat insulinoma (RIN) cell lines, RTN-14B, RIN-m5F, RIN-m, and RIN-5, to (S)-JQ1 and
  • RIN-m5F rat insulinoma cells were treated with JQl (500 nM) or
  • RNA sample preparation V2 kit The concentrations of the final library preps were 71 ng/ ⁇ and 79 ng/ ⁇ for the DMSO and JQ1 samples, respectively. Libraries were sequenced on Illumina NextSeq 500 as paired-end 75-nt reads.
  • JQ1 treatment resulted in a larger number of genes with decreased expression as compared to increased expression (Table E).

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