WO2016160718A1

WO2016160718A1 - Methods for treatment of retinal disease by photoreceptor gene expression modulation

Info

Publication number: WO2016160718A1
Application number: PCT/US2016/024549
Authority: WO
Inventors: Thomas A. Reh; Paul NAKAMURA; Sheng Ding
Original assignee: University of Washington; J David Gladstone Institutes
Current assignee: University of Washington; J David Gladstone Institutes
Priority date: 2015-03-27
Filing date: 2016-03-28
Publication date: 2016-10-06
Anticipated expiration: 2017-09-27
Also published as: US20180125847A1; US10363256B2; US20190381047A1; US10849904B2

Abstract

Methods for decreasing rod gene expression in a retina, methods for decreasing the protein products expressed by rod genes in a retina, methods for treating a disease or condition treatable by decreasing rod gene expression or their protein products in a retina, and methods for treating a retinal disease in a subject.

Description

METHODS FOR TREATMENT OF RETINAL DISEASE BY

PHOTORECEPTOR GENE EXPRESSION MODULATION

CROSS-REFERENCE TO RELATED APPLICATION This application claims the benefit of U.S. Application No. 62/139, 158, filed March 27, 2015, expressly incorporated herein by reference in its entirety.

STATEMENT OF GOVERNMENT LICENSE RIGHTS

This invention was made with Government support under Grant No. 1 ROl EY021482 awarded by the National Institutes of Health. The Government has certain rights in the invention.

BACKGROUND OF THE INVENTION

Death of photoreceptors is a common endpoint of several retinal degenerative diseases and often eventually results in blindness. In many cases of the retinal degenerative disease retinitis pigmentosa (RP), mutations in rod photoreceptor genes result in rod photoreceptor dysfunction and subsequent cell death. The majority of mutations in Rhodopsin (RHO) that cause RP are associated with the autosomal dominant form (adRP). These mutations lead to activation of the unfolded protein response (UPR) in the rods, due to a mislocalization of the mutant protein. A number of strategies are currently being pursued to reduce the UPR in the rods, or to reduce the expression of the mutant allele using siRNA. An alternative approach to modulate rod gene expression is suggested by developmental studies. During retinal development the expression of a few key transcription factors regulates photoreceptor cell fate and further specification into rod and cone photoreceptors. One critical transcription factor in the specification of cone versus rod fate is Nrl. Mice with mutations in Nrl have a retina without rods, but an increase in the number of cones because the rod precursors become cones without the expression of Nrl. Conversely, overexpression of Nrl in cone precursors results in decreased cone gene expression and a transformation to rod photoreceptors.

A recent study showed that partial transdifferentiation of mature rods into cones by conditional knockout of Nrl can prevent retinal degeneration in a mouse model of recessive RP (Rho ^~'^~ mice). This reprogramming of rods into cone-like cells prevented their death and therefore any secondary cone cell death as well. The orphan nuclear receptor Nr2e3 (also known as photoreceptor nuclear receptor) is a direct target of Nrl and is expressed in postmitotic photoreceptors soon after the onset of Nrl expression. Nr2e3 has a dual role as a transcriptional suppressor and co-activator during retinal development. It is required for the suppression of cone gene expression, as evidenced by the findings that mice with targeted or spontaneous mutations in Nr2e3 have increased expression of cone genes in rod-like photoreceptors. Additionally, Nr2e3 co-activates the transcription of rod-specific genes like Rho and Gnatl along with Crx and Nrl.

The finding that partial reprogramming of rods to cones can reduce rod death and decrease secondary cone loss to spare cone-mediated vision in a mouse model of RP provides an approach to develop therapies for this disorder and other similar degenerative diseases. This pathway is also potentially amenable to manipulation pharmacologically, since Nr2e3, the downstream target of Nrl, is a nuclear hormone receptor, and probably capable of antagonism.

Despite the advances for treating retinal disease, a need exists for improved therapeutic agents and treatments. The present invention seeks to fulfill this need and provides further related advantages.

SUMMARY OF THE INVENTION

The present invention provides methods for decreasing rod gene expression in a retina, methods for decreasing the protein products expressed by rod genes in a retina, methods for treating a disease or condition treatable by decreasing rod gene expression or their protein products in a retina, and methods for treating a retinal disease in a subject.

In one aspect, the invention provides a method for decreasing rod gene expression in a retina.

In one embodiment, the method includes contacting a retina with a compound having formula (I):

or a pharmaceutically acceptable salt thereof,

wherein R¹ is phenyl substituted with one or two groups independently selected from the group consisting of C1-C6 alkyl and halogen, and n is 0 or 1.

In another embodiment, the method includes contacting a retina with a compound having formula (II):

or a pharmaceutically acceptable salt thereof,

wherein R¹ is independently at each position a C1-C6 alkyl group, R² is selected from the group consisting of hydrogen and C1-C6 alkyl, R³ is selected from the group consisting of hydrogen and C1-C6 alkyl, and n is 0, 1, or 2.

In another aspect, the invention provides a method for reducing the expression of protein products derived from rod genes. In certain embodiments, the invention provides a method for decreasing rhodopsin expression in a retina. In one embodiment of this method, a retina is treated with a compound having formula (I) or a pharmaceutically acceptable salt thereof. In another embodiment of this method, a retina is treated with a compound having formula (II) or a pharmaceutically acceptable salt thereof.

In a further aspect of the invention, methods are provided for treating a disease or condition treatable by decreasing rod gene expression, or their protein products, in a retina. In certain embodiments, the methods include administering to a subject in need thereof a therapeutically effective amount of a compound having formula (I) or a pharmaceutically acceptable salt thereof. In other embodiments, the method includes administering to a subject in need thereof a therapeutically effective amount of a compound having formula (II) or a pharmaceutically acceptable salt thereof.

Representative diseases or conditions treatable by decreasing rod gene expression, or their protein products, in a retina include retinitis pigmentosa, retinal degeneration, macular degeneration, age-related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury. In one embodiment, the treatable disease or condition is retinitis pigmentosa.

In another aspect, the invention provides methods for treating a retinal disease in a subject. In certain embodiments, the methods include administering to a subject in need thereof a therapeutically effective amount of a compound having formula (I) or a pharmaceutically acceptable salt thereof. In other embodiments, the method includes administering to a subject in need thereof a therapeutically effective amount of a compound having formula (II) or a pharmaceutically acceptable salt thereof. Representative retinal diseases treatable by the methods of the invention include retinitis pigmentosa, retinal degeneration, macular degeneration, age-related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury. In one embodiment, the treatable disease or condition is retinitis pigmentosa.

DESCRIPTION OF THE DRAWINGS

The foregoing aspects and many of the attendant advantages of this invention will become more readily appreciated as the same become better understood by reference to the following detailed description, when taken in conjunction with the accompanying drawings.

FIGURE 1 compares relative rhodopsin expression of intact retinas from P12 wild type mice explanted in media containing DMSO, CA88 and CA8801-8816 at 1 μΜ for 2 days and then processed for qPCR.

FIGURE 2 illustrates the chemical structures of analogs CA8802-CA8816..

FIGURE 3 compares relative rhodopsin expression of intact retinas from P12 wild type mice explanted in media containing DMSO, CA95 and CA9501-9514 at 1 μΜ for 2 days and then processed for qPCR.

FIGURE 4 illustrates the chemical structures of analogs CA9501-CA9512 and CA9514.

FIGURE 5 compares cone gene expression increase for Thrb (TRP2) with CA88 and CA95.

FIGURES 6A-6E. Schematic showing experimental design for screen of small molecules (6A). RT-qPCR for rod photoreceptor genes expressed in DMSO treated controls and 1 μΜ PR1 treated retinal explants from P12 mice for 3 DIV (n = 4; *p < 0.05) (6B) Dose-response relationship of PR1 on rod specific genes Nrl, Nr2e3, and rhodopsin in P12 retinal explants (n = 3-4) (6C). Human retinal explants from 113 day post-conception fetuses were cultured in media with DMSO or 10 μΜ PR1 for 7 or 23 days; PR1 treatment decreased normalized RHO expression after 7 and 23 days in culture (6D). HEK293T cells were transfected with NR2E3, CRX, or NRL and BR-225Luc (firefly luciferase driven by the bovine rhodopsin promoter) and pRL-CMV (renilla luciferase driven by the CMV promoter; internal transfection control) and then treated with DMSO or 10 μΜ PR1 for 2 days; PR1 decreased rhodopsin promoter activity after transfection with Crx and Nrl and transfection with Nr2e3, Crx, and Nrl (n > 3; *p < 0.05, Student's t-test) (6E).

FIGURES 7A-7J. Schematic for experimental design for panels 7B-7E (7 A). Western blot for rhodopsin shows significant reduction in PO explants treated with 1 μΜ PRl for 5DIV (7B). Rhodopsin expression was normalized to β-actin; PRl -treated explants had less relative expression than DMSO controls (n = 4, *p < 0.05, Student's t-test) (7C). RT-qPCR for P0 explants treated with DMSO or 1 μΜ PRl for 2 DIV; Nrl, Nr2e3, rhodopsin, and Gnatl were significantly reduced with PRl, while Gnbl and Crx did not change; the expression of the cone gene Thrb was increased in PRl -treated explants (n=3, *p < 0.05, Student's t-test) (7D). Sections from DMSO and 1 μΜ PRl treated P0 explants stained for rhodopsin and S opsin demonstrate a decrease in rhodopsin+ cells and an increase in S opsin+ cells; scale bar represents 50 μπι (7E). Schematic for experimental design for panels 7G and 7H (7F). Timed-pregnant dams were injected with 100 μΐ of 50 mM PRl at E14 and E17 and pups were sacrificed for analysis at P0; PRl treated pups had more S opsin+ cells per 200 μπι of central retina compared to controls (n > 6 retinas from 3 animals; *p < 0.05, Student's t-test) (7G). Sections of central retina from control and PRl pups stained for S opsin; scale bar represents 50 μπι (7H). Schematic for experimental design for panel J (71). Postnatal pups were IP injected with DMSO or 20 μΐ. of 50 mM PRl at P2 or P3 and then sacrificed 24 hours later for RT-qPCR analysis; PRl decreased rhodopsin expression in P2-3 pups (n = 4-5; *p < 0.05, Student's t-test) (7 J).

FIGURES 8A-8F. Schematic for experimental design for panels B-D (8A). Retinas from P12 Nrl-eGFP mice were explanted in DMSO or 1 μΜ PRl for 5DIV; staining for GFP (Nrl), rhodopsin and S opsin in P12 explants from Nrl-eGFP mice demonstrate a decrease in rhodopsin expression and an increase in S opsin+ cells in PRl -treated retinas; scale bar represents 50 μπι (8B). PRl -treated retinas had more S opsin cells than DMSO controls per 200 μπι of central retina (n = 3, *p < 0.05, Student's t-test) (8C). Quantification of bipolar cells (PKCa, ChxlO), amacrine cells (HuCD), and Muller glia (Sox2) revealed no difference in the number of these cells (n = 3; p > 0.05, Student's t-test); however, the migration of Sox2+ Muller glia into the ONL of PRl -treated retinas was observed (arrow) (8D). EdU staining in DMSO and PRl retinal explants from P12 mice for 5DIV (8E). PRl retinal explants had more EdU+ cells than DMSO controls (n = 4, *p < 0.05, Student's t-test); scale bars in 8D and 8E represent 50 μιη (8F).

FIGURES 9A-9K. Schematic for experimental design for panels 9B-9D (9 A). Adult mice received two 1.5 [iL intravitreal injections of 10 mM PRl into one eye over a 4 day paradigm; compared to the control retina, PRl decreased rhodopsin expression in adult retinas (n = 3, *p < 0.05, Student's t-test) (9B). Western blot for rhodopsin shows that intravitreal injection of PRl decreases expression compared to the uninjected, contralateral retina of adult mice (9C). Rhodopsin expression was normalized to β-actin expression. PRl decreased the relative expression of rhodopsin after intravitreal injection in adult mice (n = 5, *p < 0.05, Student's t-test) (9D). Schematic for experimental design for panels 9F and 9G (9E). Retinas from P8 Rho^P23H mice were explanted in DMSO or 2 μΜ PRl for 3DIV; Western blot analysis shows that PRl treated Rho^P23H retinas have less mutant rhodopsin expression than DMSO controls (9F). Rhodopsin expression was normalized to β-actin expression; PRl Rho^P23H retinas had less relative expression of rhodopsin than DMSO-treated Rho^P23H controls (n = 3, *p < 0.05, Student's t-test) (9G). Schematic for experimental design for panels 9I-9K (9H). Retinas from P12 Rho^P23H mice were explanted in DMSO or 1 μΜ PRl for 6DIV; DAPI staining demonstrates that PRl treated Rho^P23H retinas had thicker O Ls in the central retina compared to DMSO treated Rho^P23H retinas (91). Quantification of DAPI+ cells in the O L 100 μιη from the optic nerve head in DMSO and PRl treated Rho^P23H retinas (n = 3, *p < 0.05, Student's t-test) (9 J). RT-qPCR analysis of Gnbl expression in DMSO and PRl Rho^P23H retinas suggests greater rod survival with PRl treatment, since PRl does not affect expression of this rod-specific transcript (n = 3, *p < 0.05, Student's t-test) (9K).

DETAILED DESCRIPTION OF THE INVENTION

The present invention provides methods for decreasing rod gene expression in a retina, methods for decreasing the protein products (e.g., rhodopsin) expressed by rod genes in a retina, methods for treating a disease or condition treatable by decreasing rod gene expression or their protein products in a retina, and methods for treating a retinal disease in a subject. In the methods, the retina or subject are treated with select small molecules to achieve the advantageous result of decreasing rod gene expression, thereby decreasing the expression of their protein products, and consequently treating a disease or condition treatable by decreasing rod gene expression or their protein products. The select small molecules are effective for treating retinal diseases such as retinitis pigmentosa (RP).

Decreasing Rod Gene Expression and Their Protein Products

or a pharmaceutically acceptable salt thereof,

As used herein the C1-C6 alkyl refers to straight chain, branched, and cycloalkyl groups. Representative alkyl groups include methyl, ethyl, n-propyl, i-propyl, n-butyl, n-pentyl, and n-hexyl groups; and cyclopropyl, cyclobutyl, cyclopentyl, and cyclohexyl groups.

The term "halogen" includes fluoro, chloro, and bromo groups.

In certain embodiments, the compound of formula (I) includes a single alkyl group (e.g., methyl, ethyl, i-propyl). In other embodiments, the compound of formula (I) includes a single halogen group (e.g., fluoro or bromo).

In certain embodiments, the compound of formula (I) includes two alkyl groups

(e.g., dimethyl). In other embodiments, the compound of formula (I) includes an alkyl group and a halogen group (e.g., methyl and bromo). In further embodiments, the compound of formula (I) includes two halogen groups (e.g., difluoro).

The compounds of formula (I) can be prepared by the following synthetic reaction scheme:

In certain embodiments, the compound of formula (I) is CA88:

In other embodiments, the compound of formula (I) is CA8801 :

Compounds CA88 and CA8801 are commercially available from ChemDiv (San Diego, CA).

Rod genes whose expression are effectively reduced in the practice of the methods of the invention include Nrl, Nr2e3, Rho, Gnatl, and Pde6b. The effectiveness of CA88 and CA8801 in reducing rhodopsin expression in intact retinas from P12 wild type mice explanted in media at 1 uM for 2 days is shown in FIGURE 1. FIGURE 1 compares relative rhodopsin expression for CA88 and CA8801 to dimethylsulfoxide (control) and related analogs 8802-8816. The chemical structures of analogs 8802-8816 are shown in FIGURE 2.

or a pharmaceutically acceptable salt thereof,

wherein R¹ is independently at each position a C1-C6 alkyl group, R² is selected from the group consisting of hydrogen and C1-C6 alkyl, R³ is selected from the group consisting of hydrogen and C1-C6 alkyl, and n is 0, 1, or 2. C1-C6 alkyl is as described above for the compounds of formula (I). R¹ may be a substituent at any carbon of the phenyl group.

In certain embodiments, the compounds of formula (II) have R¹ selected from C1-C4 alkyl (e.g., methyl), n = 1, R² selected from hydrogen and C1-C4 alkyl (e.g., i-propyl), and R³ selected from C1-C4 alkyl (e.g., methyl). In one embodiment, R¹ is methyl, n = 1, R² is i-propyl, and R³ is methyl). In another embodiment, R¹ is methyl, n = 1, R² is hydrogen, and R³ is methyl.

The compounds of formula (II) can be prepared by the following synthetic reaction scheme:

In certain embodiments, the compound of formula (II) is CA95:

In other embodiments, the compound of formula (II) is CA9513 :

Compounds CA95 and CA9513 are commercially available from ChemDiv (San Diego, CA).

Rod genes whose expression are effectively reduced in the practice of the invention include Nrl, Nr2e3, Rho, and Gnatl. The effectiveness of CA95 and CA9513 in reducing rhodopsin expression in intact retinas from P12 wild type mice explanted in media at 1 uM for 2 days is shown in FIGURE 3. FIGURE 3 compares relative rhodopsin expression for CA95 and CA9513 to dimethyl sulfoxide (control) and related analogs 9501-9512 and 9514. The chemical structures of analogs 9501-9512 and 9514 are shown in FIGURE 4.

In certain embodiments of the above methods, contacting the retina comprises systemic administration of the compound to the subject or intravitreal injection of the compound.

In another aspect, the invention provides a method for reducing the expression of protein products derived from rod genes. In certain embodiments, the invention provides a method for decreasing rhodopsin expression in a retina.

In one embodiment of this method, a retina is treated with a compound having formula (I) or a pharmaceutically acceptable salt thereof, as described above. In certain of these embodiments, the compound of formula (I) is CA88. In other of these embodiments, the compound of formula (I) is CA8801.

In another embodiment of this method, a retina is treated with a compound having formula (II) or a pharmaceutically acceptable salt thereof, as described above. In certain of these embodiments, the compound of formula (II) is CA95. In other of these embodiments, the compound of formula (II) is CA9513.

In certain embodiments of the above methods, treating the retina comprises systemic administration of the compound to the subject or intravitreal injection of the compound.

Treating Diseases or Conditions Treatable by Decreasing Rod Gene Expression or

Their Protein Products

In a further aspect of the invention, methods are provided for treating a disease or condition treatable by decreasing rod gene expression, or their protein products, in a retina.

In certain embodiments, the methods include administering to a subject in need thereof a therapeutically effective amount of a compound having formula (I) or a pharmaceutically acceptable salt thereof, as described above. In certain of these embodiments, the compound of formula (I) is CA88. In other of these embodiments, the compound of formula (I) is CA8801.

In other embodiments, the method includes administering to a subject in need thereof a therapeutically effective amount of a compound having formula (II) or a pharmaceutically acceptable salt thereof, as described above. In certain of these embodiments, the compound of formula (II) is CA95. In other of these embodiments, the compound of formula (II) is CA9513.

In certain embodiments of the above methods, administering the compound comprises systemic administration of the compound to the subject or intravitreal injection of the compound.

Treating Retinal Disease

In another aspect, the invention provides methods for treating a retinal disease in a subject.

Representative retinal diseases treatable by the methods of the invention include retinitis pigmentosa, retinal degeneration, macular degeneration, age-related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury. In one embodiment, the treatable disease or condition is retinitis pigmentosa.

In certain embodiments of the above methods, administering the compound comprises systemic administration of the compound to the subject or intravitreal injection of the compound. In the methods of the invention that are methods of treatment, the term "therapeutically effective amount" refers to an amount effective, at dosages and for periods of time necessary, to achieve the desired therapeutic result, such as reduced levels of rod gene expression or their protein products. A therapeutically effective amount of a compound may vary according to factors such as the disease state, age, sex, and weight of the subject, and the ability of the compound to elicit a desired response in the subject. Dosage regimens can be adjusted to provide the optimum therapeutic response. A therapeutically effective amount is also one in which any toxic or detrimental effects of the administered compound are outweighed by the therapeutically beneficial effects.

It is to be noted that dosage values can vary with the severity of the condition to be alleviated. For any particular subject, specific dosage regimens can be adjusted over time according to the individual need and the professional judgment of the person administering or supervising the administration of the compositions. Dosage ranges set forth herein are exemplary only and do not limit the dosage ranges that can be selected by a medical practitioner. The amount of active compound in the composition can vary according to factors such as the disease state, age, sex, and weight of the subject. Dosage regimens can be adjusted to provide the optimum therapeutic response. For example, a single bolus can be administered, several divided doses can be administered over time or the dose can be proportionally reduced or increased as indicated by the exigencies of the therapeutic situation.

In the methods, the administration of the compound can be a local administration (e.g., administration to the eye), or systemic administration to the subject. The term "subject" is intended to include mammalian organisms. Examples of subjects include humans and non-human mammals. In specific embodiments of the invention, the subject is a human.

The terms "administering," "contacting," or "treating" include any method of delivery of a compounds or a pharmaceutical composition comprising the compound into a subject's system or to a particular region of the subject (e.g., eye). Increasing Cone Gene Expression Methods

In further aspects, the invention provides methods for increasing cone gene expression, or their protein products, in a retina.

In one embodiment of this method, a retina is treated or contacted with a compound having formula (I) or a pharmaceutically acceptable salt thereof, as described above. In certain of these embodiments, the compound of formula (I) is CA88. In other of these embodiments, the compound of formula (I) is CA8801.

In another embodiment of this method, a retina is treated or contacted with a compound having formula (II) or a pharmaceutically acceptable salt thereof, as described above. In certain of these embodiments, the compound of formula (II) is CA95. In other of these embodiments, the compound of formula (II) is CA9513.

In certain embodiments of the above methods, treating or contacting the retina comprises systemic administration of the compound to the subject or intravitreal injection of the compound.

Cone genes whose expression that are effectively increased in the practice of the invention include MOps, S Ops, Gnat2, Gnb3, Rxrg, Τ β2, and Pde6h.

In a related aspect, the invention provides a method for increasing Ττβ2 expression in a retina.

FIGURE 5 compares cone gene expression increase for Thrb (Τ β2) with CA88 and CA95.

In certain embodiments of the above methods, treating or contacting the retina comprises systemic administration of the compound to the subject or intravitreal injection of the compound. Pharmaceutical Compositions

In another aspect, the invention provides a pharmaceutical composition that includes a pharmaceutically acceptable carrier and a compound having formula (I) or formula (II) or a pharmaceutically acceptable salt thereof, are described above. In certain embodiments, the compound is CA88, CA8801, CA95, or CA9513.

Suitable carriers include those suitable for administration to an animal (e.g., a human subject). Pharmaceutical compositions suitable for injectable use include sterile aqueous solutions (e.g., saline, dextrose) and dispersions.

The compositions of the invention can be orally administered, for example, with an inert diluent or carrier, enclosed in hard or soft shell gelatin capsule, or compressed into tablets. For oral therapeutic administration, the compounds and compositions can be combined with excipients and used in the form of ingestible tablets, buccal tables, troches, capsules, elixirs, suspensions, syrups, wafers, and the like. The amount of active compounds in such therapeutically useful compositions is such that a suitable dosage is obtained.

The compounds and compositions of the invention can be administered parenterally. Solutions of the compounds as free base or pharmacologically acceptable salts can be prepared in water suitably mixed with additives, such as surfactants. Dispersions can also be prepared in in oils.

The following description relates to a small molecule antagonist of Nr2e3a useful in the methods of the invention. More particularly, the following describes small molecule reprogramming of rod photoreceptors to treat retinitis pigmentosa (RP).

As described herein, small molecule antagonists of Nr2e3 have been identified using intact developing retinas and these compounds have significant and selective effects on rod gene expression. On such putative Nr2e3 antagonist is N-(3,5-dimethylphenyl)-3-(4-oxo-5,6,7,8-tetrahydro-3H-[l]benzothiolo[2,3-d]pyrimidin- 2-yl)propanamide, referred to herein is as "CA88" or "Photoregulinl " or "PR1." PR1 was found to decrease the expression of rod genes and increased the number of S opsin+ cones. PR1 also slowed degeneration of photoreceptors in an in vitro model of RP, providing evidence that chemical probes targeted against Nr2e3 may be therapeutically useful for the treatment of retinal degenerative diseases. Screen of putative chemical probes of Nr2e3 with intact retinal explant cultures. To identify functional Nr2e3 antagonists, compounds were cheminformatically searched and structural analogs of a putative Nr2e3 interacting compound with unknown function were collected. See FIGURES 2 and 4 for the structures of the compounds. The collected compounds were then screened in a physiologically relevant primary culture assay using intact retinas from postnatal day 12-13 (P12-13) C57BL/6 mice for suppression of Rho expression (See FIGURE 6A). After a 2 day culture period with media containing DMSO or compounds at 1 μΜ, the retinas were collected and assessed Rho expression by qPCR. Rho was chosen because it is a well-described target of Nr2e3 in rod photoreceptors. Photoregulinl (PRl) was found to substantially decrease Rho expression compared to DMSO in retinal explants from P12-13 mice (FIGURE 6B). This analysis also provided an initial structure-activity relationship.

Nr2e3 loss-of-function mutations lead to a reduction in rod gene expression. To determine whether the same was true for PRl (FIGURE 6D), explant cultures of P12 retina as above were treated and assayed for other rod photoreceptor genes. After 2 days in culture, PRl decreased the expression of the rod specific genes Nrl, Nr2e3, Rho, Gnatl, and Pde6b compared to DMSO treatment by qPCR analysis (FIGURE 6C). However, PRl did not significantly decrease the expression of Gnbl or Crx, suggesting that PRl was not causing a general loss of photoreceptors. To determine the dose-response relationship between PRl concentration and expression of rod genes, retinas from P12 mice were explanted in media containing DMSO or 0.1, 1, 5, or 10 μΜ PRl for 2-3 days and assayed Nrl, Nr2e3, and Rho expression by qPCR. Some effect of PRl at a concentration as low as 0.1 uM was observed for all three rod genes tested, but statistically significant reductions were observed with the higher concentrations (FIGURE 6E). PRl was tested to determine whether it could cause a reduction in Rho expression in human rod photoreceptors as well. Pairs of 113 day post-conception retinas were explanted in media with DMSO or 10 μΜ PRl for 7 or 23 days. After 7 and 23 days in culture, PRl decreased the expression of Rho compared to DMSO treatment (FIGURE 6F), similar to the effect observed in mouse retinal explants.

Nr2e3, Crx, and Nrl are known to activate rod gene expression by forming a complex at the promoters of rod genes. To test whether PRl might interfere with this complex, a luciferase reporter assay was used. For this assay, the rhodopsin promoter driving firefly luciferase was co-transfected with Nrl, Nr2e3, or Crx or all of these transcription factors together into HEK293T cells. A large synergy in the activation of the rhodopsin reporter was found with the combination of these three transcription factors (FIGURE 6G). When PRl was added to the cells, a large reduction in the activation of the rhodopsin promoter reporter was observed after transfection with all three factors or with Crx and Nrl (FIGURE 6G).

Effects of PRl on developing retina

Loss-of-function mutations in Nr2e3 cause an increase in the number of S-opsin+ photoreceptors and a decrease in rhodopsin expression. To determine whether PRl has similar effects on developing photoreceptors, retinas from P0 mice were explanted in media containing DMSO or 1 μΜ PRl and assessed the level of rod genes with Western blots and qPCR after two to five days in vitro (FIGURE 7A). When the P0 retina explants were analyzed by Western blot, those treated with PRl expressed less rhodopsin protein than DMSO controls (FIGURES 7B and 7C). Expression of additional genes was tested using qPCR. After 2 days in culture PRl decreased the expression of the rod specific genes Nrl, Nr2e3, Rho, and Gnatl compared to DMSO (FIGURE 7D). However, PRl did not significantly decrease the expression of Gnbl, Crx, or Otx2, suggesting that PRl was not causing a general loss of photoreceptors. Immunohistochemical analysis of sections of the explants were carried out, and observed an almost complete absence of rhodopsin immunoreactivity in the PRl treated explants (FIGURE 7E). Interestingly, PRl treatment increased the expression of the cone gene, Thrb (FIGURE 7D) by qPCR, and there was an overall increase in the level of S opsin immunoreactvity in sectioned explants treated with PRl (FIGURE 7E, inset) when compared with DMSO treated control retinal explants.

Nr2e3 is expressed in developing rods prior to birth, and so to test whether PRl could affect prenatal rod development, wild type timed-pregnant dams were injected with 100 μΐ of 50 mM PRl at E14 and El 7, during peak S cone photoreceptor genesis and the onset of Nr2e3 expression (FIGURE 7F). The pups were sacrificed at P0 and their retinas collected for staining and for quantifying S opsin+ photoreceptors. Pups born from the PRl -injected dams were found to have an increase in the number of S opsin-positive cells when compared with controls (FIGURES 7G and 7H). To determine if PRl affected rhodopsin expression in developing rods in vivo, pups were injected with 20 μΐ of 50 mM PRl or an equal volume of DMSO at P2 or P3 (FIGURE 71). The pups were sacrificed the following day and analyzed rhodopsin expression by qPCR. Pups intraperitoneally (IP) injected with PRl had decreased rhodopsin compared to pups injected with DMSO (FIGURE 7 J). Together these results show that PRl affects S opsin and rhodopsin in developing retina like an Nr2e3 loss-of-function mutation.

Effects of PRl at later stages of retinal development

Previous loss of function genetic data has shown that Nr2e3 is required for rod photoreceptor development, but it is not known whether there is a continuing requirement for Nr2e3 in mature rods. The results from the studies of retinal explants at P12 described herein suggest a continuing role for Nr2e3 in rhodopsin expression (FIGURES 6C and 6E). To further examine the effects of PRl at these late developmental stages, the effects of PRl on P12 retinal explants by immunohistochemical analysis were studied (FIGURE 8A). Explants from P12 Nrl- eGFP mice were cultured for 5 days in either DMSO or 1 μΜ PRl containing media, and then fixed and processed for immunofluorescent labeling with anti-rhodopsin and anti-S opsin antibodies. The PRl -treated explants showed a dramatic decrease in rhodopsin staining in Nrl-GFP-positive rods. An increase in the number of S opsin+ cells in the O L was also observed (FIGURE 8B and 8C). Thus, PRl has effects on rod and cone gene expression, even at late stages of photoreceptor development, suggestive of a continued requirement for Nr2e3 in rod differentiation, after their initial cell fate commitment.

To determine if PRl affects retinal cells other than photoreceptors, bipolar cells

(PKCa, ChxlO), amacrine cells (HuCD), and Muller glia (Sox2) were quantified in explants treated with DMSO or 1 μΜ PRl for 5 DIV. No differences in the appearance of these other types of neurons were found between the DMSO and PRl treated retinas. However, an increase in the migration of the Muller glial (Sox2+) nuclei into the ONL in the treated retinas was consistently observed (FIGURE 8D). Previous studies have also suggested that loss of Nr2e3 leads to an increase in cone progenitor proliferation, and this might explain the increase in cones observed in the mutant. EdU (5-ethynyl-2'- deoxyuridine) was added to the cultures to determine whether PRl might have a similar effect. Although there was an increase in the number of EdU labeled cells in the PRl treated explants, the number of labeled cells was small overall and could not account for PRl's large effects on photoreceptor gene expression. Based on the immunohistochemical data, PRl does not cause other widespread changes in other cell types in the retina. PRl reduces rhodopsin expression in the retinas of adult mice

Conditional deletion of Nr2e3 in mature photoreceptors has not been reported; however, deletion of Nrl in mature photoreceptors leads to a partial "reprogramming" of the rods: the cells have reduced rod gene expression and an increase in the expression of some cone genes. Because PRl reduces rod gene expression, including Nrl, in rods even at late stages in their development (P12), it was postulated that PRl might have similar effects in the retinas of adult mice. To determine if PRl affects adult photoreceptor gene expression in vivo, intravitreal injections in one eye of an adult mouse (>P21) were made and compared expression to the other eye. It was found that two intravitreal injections of PRl, made over a four day period (FIGURE 9 A), decreased the expression of Rho mRNA assessed by qPCR (FIGURE 9B) and protein, by Western blot analysis (FIGURES 9C and 9D). Interestingly, PRl increased the expression of the cone photoreceptor marker TRP2 in adult retinas, although an increase in S opsin at this age was not observed.

PRl slows degeneration of rods in Rhodopsin^P23H retinas

The effect of PRl on Rho expression in adult rods might have potential as a way to slow the degeneration of these cells in dominant forms of retinitis pigmentosa, like Rho^P23H. In this disease, the affected individuals express a mutant form of rhodopsin that is likely inappropriately processed and ultimately leads to the death of the rods. To test whether reducing rhodopsin expression with PRl might slow the degeneration of these cells, retina from Rho^P23H transgenic mice at P8 were explanted in media containing DMSO or 2 μΜ PRl and maintained the explants for three days (FIGURE 9E). It was found that PRl effectively reduced rhodopsin expression in the mutant rods (FIGURES 9F and 9G), similar to what occurs in the wild type retina. The majority of rod cell death in the Rho^P23H transgenic line occurs between P14 and P21. Therefore, explants of retinas from Rho^P23H mice at P12 were made and treated the explants with ΙμΜ PRl or DMSO (FIGURE 9H). After 6 days in vitro, the retinas were processed for histology. The number of nuclei were counted in the ONL of each retina in the central region 100 μιη from the optic nerve head. PRl -treated retinas were found to have on average nearly twice the number of rod photoreceptors in the ONL than DMSO treated controls (FIGURE 91 and 9J). Gnbl expression was also monitored as another measure of rod photoreceptor preservation because this is not directly affected by PRl and thus serves as a surrogate for rod number. The PRl treated explants had significantly more Gnbl expression than the sister cultures treated with DMSO (FIGURE 9K). The studies described herein provide the first demonstration of small molecule repression of rod gene expression for the potential treatment of dominant retinitis pigmentosa. The expression of Crx, Otx2, Nrl, and Nr2e3 in mature rods is consistent with their role in the maintenance of proper photoreceptor gene expression and homeostasis. By screening compounds on rod gene expression in intact retina in vitro, a subset of compounds was found that inhibited the expression of rhodopsin in the screen. PRl was found to inhibit expression of rod genes in developing and mature rod photoreceptors. The activity of PRl on rod photoreceptors phenocopies loss-of-function mutations in Nr2e3, and significantly reduces expression from the rhodopsin promoter in HEK293T cells transfected with Nr2e3, Crx and Nrl. Together the data supports the conclusion that PRl directly interacts with Nr2e3 and acts to antagonize its activity.

The primary effect observe after treatment of the retina, either in vitro or in vivo, is a reduction in the expression of rod photoreceptor specific genes, like Rho, Gnatl, and Pde6b. However, not all rod genes are reduced to the same extent; no changes in Gnbl expression for example. Moreover, both Nrl and Nr2e3 are significantly reduced by PRl treatment at either P0 or P12, and some of the effects observed on rod gene expression may be due to the reduction in these transcription factors. Similar results are seen after conditional knockout of Nrl in adult mice, in that rod genes are more affected than cone genes. Additionally, fewer cone genes are upregulated following knockout in the adult compared to germline knockout of Nrl, possibly due to developmental changes in the methylation status of cone gene promoters. Nonetheless, this partial "reprogramming" via conditional knockout of Nrl is sufficient to prevent photoreceptor degeneration in the Rho knockout model of RP, similar to findings with the Rho^P23H model in vitro. Together, these studies demonstrate that downregulation of rod gene program in degenerative diseases that primarily affect rods may be an effective strategy for treatment in humans. Suppression of rhodopsin or other commonly mutated rod genes with siRNAs may also be similarly effective.

Interestingly, PRl's effects on rod gene expression are much more pronounced than the effects reported from Nr2e3 loss-of-function models, such as the Rd7 mouse and the targeted knockout of Nr2e3. In these mice, rod genes like Rho and Gnatl are only modestly reduced, while we observed large changes with PRl treatment. This difference may be due to our finding that PRl also decreases the expression of Nrl, while these genetic mutations do not, and Nrl may be sufficient to drive rod gene expression in the absence of Nr2e3. In addition to changes in the expression of rod genes, Rd7 mice show a derepression of cone genes. Similarly, mutations in Nr2e3 can cause enhanced S-cone syndrome and patients present increased sensitivity to blue light. Large increases in S-opsin expression that were expected from antagonism of Nr2e3, particularly in the mature retina, were not observed. It is possible that PRl selectively affects the ability of Nr2e3 to act as a transcriptional activator (inhibiting its ability to form a complex with Crx and Nrl), but has less of an effect on its repressor functions. However, it is also possible that acute loss of Nr2e3 has different effects than developmental deletions.

The studies described herein demonstrate that small molecules can regulate rhodopsin gene expression in developing and mature retina, and provide a novel approach to the treatment of dominant forms of RP. The ability to modulate rod and cone gene expression may also have utility in recessive forms of the disease, because conditional deletion of Nrl in mature mice provided rod protection in the Rho^'1'.

MATERIALS AND METHODS Animals

C57B1/6 (Jackson Stock No: 000664), Rho^P2m (Jackson Stock No: 017628) and Nrl-eGFP (Jackson Stock No: 021232) mice were used at the indicated ages. All mice were housed by the Department of Comparative Medicine at the University of Washington and protocols were approved by the University of Washington Institutional Animal Care and Use Committee.

Small Molecules

Photoregulinl and analogs were identified by searching previous small molecule screens with SciFinder for Nr2e3 interacting molecules. All of the putative Nr2e3 interacting molecules specifically identified herein were obtained commercially from ChemDiv (San Diego, CA).

Retinal Explant Cultures

Intact retinas without RPE from mice of various strains and ages as indicated were explanted on 0.4 μπι pore tissue culture inserts (Millipore) as previously described (Ueki, Y., et al., P53 is required for the developmental restriction in Muller glial proliferation in mouse retina. Glia, 2012. 60(10): p. 1579-89; Ueki, Y., et al., A transient wave of BMP signaling in the retina is necessary for Muller glial differentiation. Development, 2015. 142(3): p. 533-43. Full media (DMEM/F12 (1 : 1) containing 1% dialyzed FBS, 1% Pen Strep, 0.3% D+ glucose, 2% B27, and 1% N2) changes were performed every other day and small molecules were used at 0.1 μΜ to 10 μΜ. Where indicated, EdU (Invitrogen) was included in the media at 5 μg/mL and visualized by staining with the Click-iT EdU Alexa Fluor kit (Thermo Fisher Scientific). For human retinal explant cultures, tissue from 113 day post-conception fetuses was obtained from the University of Washington Birth Defects Laboratory and explanted on 0.4 μπι pore tissue culture inserts (Millipore) in media (Neurobasal A with 1% FBS, 1% Pen Strep, 1% N2, 1% B27) containing 10 μΜ Photoregulinl or an equal volume of DMSO.

Quantitative real-time PCR

RNA was isolated using TRIzol (Invitrogen) and cDNA was synthesized using the iScript cDNA synthesis kit (Bio-Rad) following an intervening DNase treatment with RQ1 RNase-free DNase (Promega). SSO Fast (Bio-Rad) was used for quantitative real-time PCR. For analysis, values were normalized to Gapdh and AACt between DMSO and compound-treated samples was expressed as percent of DMSO treated controls (100*2^AAACt ). Two-way Student's t-tests were performed on ACt values.

Immunofluorescence

Retinal explants or eyecups were fixed in 4% PFA in IX PBS for 20 minutes at room temperature and then cryoprotected in 30% sucrose in IX PBS overnight at 4°C. Samples were embedded in OCT (Sakura Finetek), frozen on dry ice, and then sectioned at 14-16 μπι on a cryostat (Leica). Slides were blocked with a solution containing 10% Normal Horse Serum (Vector Labs) and 0.5% Triton X-100 (Sigma-Aldrich) in IX PBS for 1 hour at room temperature and then stained overnight at 4°C with primary antibodies diluted in blocking solution. Slides were washed three times with IX PBS the following day and then incubated in secondary antibodies (Life Technologies) diluted in blocking solution for 2 hours at room temperature, stained with DAPI (Sigma-Aldrich), washed, and coverslipped using Fluoromount-G (SouthernBiotech). An Olympus FluoView F VI 000 was used for confocal microscopy.

Western Blots

Retinal explants or retinas were homogenized in lysis buffer (50 mM Tris, 100 mM NaCl, 5 mM EDTA, 0.1% SDS, 1% Triton X-100, 2.5% glycerol, and IX protease inhibitor cocktail) and equal amounts of protein samples were loaded and run in a 4-20% SDS gel (Bio-Rad). Protein was transferred to a PVDF membrane (Thermo Fisher Scientific), blocked (5% BSA and 0.1% Tween 20 in IX PBS) and stained with primary antibodies (Supplemental Table S2) and then HRP-conjugated secondaries (Bio-Rad) diluted in blocking solution. Signals were visualized on X-ray film with SuperSignal West Dura Extended Duration Substrate (Thermo Fisher Scientific) and quantified using ImageJ software (NIH).

Dual Luciferase Assay

HEK293T cells were transfected with ^g of the luciferase reporter BR-225Luc, 1 ng of the control pRL-CMV (Promega) and 100 ng of h RL-pCMVSport6 (Open Biosystems), hCRX-pCMVSport6 (Open Biosystems), or h R2E3-pcDNA3.1/HisC in 24 well plates using Lipofectamine 3000 reagent (Thermo Fisher Scientific). Transfection reagents were removed the following day and replaced with media containing DMSO or 10 μΜ PR1 for 2 days. Cells were lysed and firefly and renilla luciferase activity was measured with the Dual-Luciferase Reporter Assay System (Promega) using a 1420 Multilabel Victor3V plate reader.

Injections

For intravitreal injections, adult mice (>P21) were anesthetized with isoflurane and injected with 1.5 μΐ of 10 mM PR1 using a 32-gauge Hamilton needle. Postnatal pups were injected intraperitoneally (IP) with 20 μΐ of 50 mM PR1 or 20 μΐ of DMSO at P2 or P3 with a 32-gauge Hamilton needle. Timed-pregnant dams were injected IP with 100 μΐ of 50 mM PR1 at E14 and E17 with a BD insulin syringe.

While illustrative embodiments have been illustrated and described, it will be appreciated that various changes can be made therein without departing from the spirit and scope of the invention.

Claims

CLAIMS The embodiments of the invention in which an exclusive property or privilege is claimed are defined as follows:

1. A method for decreasing rod gene expression in a retina, comprising contacting a retina with a compound having formula (I):

or a pharmaceutically acceptable salt thereof,

2. The method of Claim 1, wherein the compound is CA88 or CA8801.

3. The method of Claim 1, wherein the rod gene is selected from the group consisting of Nrl, Nr2e3, Rho, Gnatl, and Pde6b.

4. The method of Claim 1, wherein contacting the retina comprises systemic administration or intravitreal injection.

5. A method for treating a disease or condition treatable by decreasing rod gene expression in a retina, comprising administering to a subject in need thereof a therapeutically effective amount of a compound having formula (I):

or a pharmaceutically acceptable salt thereof,

6. The method of Claim 5, wherein the compound is CA88 or CA8801.

7. The method of Claim 5, wherein the disease or condition is selected from the group consisting of retinitis pigmentosa, retinal degeneration, macular degeneration, age-related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury.

8. The method of Claim 5, wherein the retinal disease is retinitis pigmentosa.

9. The method of Claim 5, wherein administering the compound comprises systemic administration or intravitreal injection.

10. A method for decreasing rhodopsin expression in a retina, comprising treating a retina with a compound having formula (I):

or a pharmaceutically acceptable salt thereof,

11. The method of Claim 10, wherein the compound is CA88 or CA8801.

12. A method of treating a retinal disease in a subject, comprising administering to a subject in need thereof a therapeutically effective amount of a compound having formula (I):

or a pharmaceutically acceptable salt thereof,

13. The method of Claim 12, wherein the compound is CA88 or CA8801.

14. The method of Claim 12, wherein the retinal disease is selected from the group consisting of retinitis pigmentosa, retinal degeneration, macular degeneration, age- related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury.

15. The method of Claim 12, wherein the retinal disease is retinitis pigmentosa.

16. The method of Claim 12, wherein the subject is a human.

17. The method of Claim 12, wherein the administering the compound comprises systemic administration or intravitreal injection.

18. A method for decreasing rod gene expression in a retina, comprising contacting a retina with a compound having formula (II):

or a pharmaceutically acceptable salt thereof,

19. The method of Claim 18, wherein the compound is CA95 or CA9513.

20. The method of Claim 18, wherein the rod gene is selected from the group consisting of Nrl, Nr2e3, Rho, and Gnatl.

21. The method of Claim 18, wherein contacting the retina comprises systemic administration or intravitreal injection.

22. A method for treating a disease or condition treatable by decreasing rod gene expression in a retina, comprising administering to a subject in need thereof a therapeutically effective amount of a compound having formula (II):

or a pharmaceutically acceptable salt thereof,

23. The method of Claim 22, wherein the compound is CA95 or CA9513.

24. The method of Claim 22, wherein the disease or condition is selected from the group consisting of retinitis pigmentosa, retinal degeneration, macular degeneration, age-related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury.

25. The method of Claim 22, wherein the retinal disease is retinitis pigmentosa.

26. The method of Claim 22, wherein administering the compound comprises systemic administration or intravitreal injection.

27. A method for decreasing rhodopsin expression in a retina, comprising treating a retina with a compound having formula (II):

or a pharmaceutically acceptable salt thereof, wherein R¹ is independently at each position a C1-C6 alkyl group, R² is selected from the group consisting of hydrogen and C1-C6 alkyl, R³ is selected from the group consisting of hydrogen and C1-C6 alkyl, and n is 0, 1, or 2.

28. The method of Claim 27, wherein the compound is CA95 or CA9513.

29. A method of treating a retinal disease in a subject, comprising administering to a subject in need thereof a therapeutically effective amount of a compound having formula (II):

or a pharmaceutically acceptable salt thereof,

30. The method of Claim 29, wherein the compound is CA95 or CA9513.

31. The method of Claim 29, wherein the retinal disease is selected from the group consisting of retinitis pigmentosa, retinal degeneration, macular degeneration, age- related macular degeneration, Stargardt's macular dystrophy, retinal dystrophy, Sorsby's fundus dystrophy, diabetic retinopathy, diabetic maculopathy, retinopathy of prematurity, and ischemia reperfusion related retinal injury.

32. The method of Claim 29, wherein the retinal disease is retinitis pigmentosa.

33. The method of Claim 29, wherein the subject is a human.

34. The method of Claim 29, wherein the administering the compound comprises systemic administration or intravitreal injection.