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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
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/513—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim having oxo groups directly attached to the heterocyclic ring, e.g. cytosine
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  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
  • C07D401/02—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings
  • C07D401/06—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing two hetero rings linked by a carbon chain containing only aliphatic carbon atoms
• • 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
  • A61K31/435—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with one nitrogen as the only ring hetero atom
  • A61K31/44—Non condensed pyridines; Hydrogenated derivatives thereof
  • A61K31/445—Non condensed piperidines, e.g. piperocaine
  • A61K31/4523—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems
  • A61K31/4545—Non condensed piperidines, e.g. piperocaine containing further heterocyclic ring systems containing a six-membered ring with nitrogen as a ring hetero atom, e.g. pipamperone, anabasine
• • 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
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/496—Non-condensed piperazines containing further heterocyclic rings, e.g. rifampin, thiothixene or sparfloxacin
• • 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
  • A61K31/495—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
  • A61K31/505—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
  • A61K31/506—Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim not condensed and containing further heterocyclic rings
• • 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
  • A61K31/535—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with at least one nitrogen and one oxygen as the ring hetero atoms, e.g. 1,2-oxazines
  • A61K31/5375—1,4-Oxazines, e.g. morpholine
  • A61K31/5377—1,4-Oxazines, e.g. morpholine not condensed and containing further heterocyclic rings, e.g. timolol
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P21/00—Drugs for disorders of the muscular or neuromuscular system
• • 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
  • A61P3/04—Anorexiants; Antiobesity agents
• • 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
  • A61P5/00—Drugs for disorders of the endocrine system
  • A61P5/48—Drugs for disorders of the endocrine system of the pancreatic hormones
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D401/00—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom
  • C07D401/14—Heterocyclic compounds containing two or more hetero rings, having nitrogen atoms as the only ring hetero atoms, at least one ring being a six-membered ring with only one nitrogen atom containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D405/00—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom
  • C07D405/14—Heterocyclic compounds containing both one or more hetero rings having oxygen atoms as the only ring hetero atoms, and one or more rings having nitrogen as the only ring hetero atom containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D409/00—Heterocyclic compounds containing two or more hetero rings, at least one ring having sulfur atoms as the only ring hetero atoms
  • C07D409/14—Heterocyclic compounds containing two or more hetero rings, at least one ring having sulfur atoms as the only ring hetero atoms containing three or more hetero rings
• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D491/00—Heterocyclic compounds containing in the condensed ring system both one or more rings having oxygen atoms as the only ring hetero atoms and one or more rings having nitrogen atoms as the only ring hetero atoms, not provided for by groups C07D451/00 - C07D459/00, C07D463/00, C07D477/00 or C07D489/00
  • C07D491/02—Heterocyclic compounds containing in the condensed ring system both one or more rings having oxygen atoms as the only ring hetero atoms and one or more rings having nitrogen atoms as the only ring hetero atoms, not provided for by groups C07D451/00 - C07D459/00, C07D463/00, C07D477/00 or C07D489/00 in which the condensed system contains two hetero rings
  • C07D491/10—Spiro-condensed systems
  • C07D491/107—Spiro-condensed systems with only one oxygen atom as ring hetero atom in the oxygen-containing ring

Definitions

• the present invention is directed to a method of treating obesity, metabolic syndrome and/or diabetes.
• the invention provides methods of treating these metabolic disorders with USP19 inhibitor compounds, and further provides those compounds for use in methods of treating obesity, metabolic syndrome and/or diabetes.
• the present invention is also directed to a method of treating muscular atrophy, for example cachexia or sarcopenia.
• the invention provides methods of treating muscular atrophy with USP19 inhibitor compounds, plus those compounds for use in methods of treating muscular atrophy.
• Obesity is associated with co-morbidities including cardiovascular diseases (e.g. coronary heart disease, hypertension and stroke), osteoarthritis, and pulmonary diseases (e.g. sleep apnoea). Obesity is also associated with metabolic disorders such as metabolic syndrome, type II diabetes and glucose intolerance.
• cardiovascular diseases e.g. coronary heart disease, hypertension and stroke
• osteoarthritis e.g. osteoarthritis
• pulmonary diseases e.g. sleep apnoea
• metabolic disorders such as metabolic syndrome, type II diabetes and glucose intolerance.
• Insulin resistance is characterised by a reduced or refractory response to insulin produced by the body, resulting in symptoms such as hyperglycaemia, hyperlipidaemia and/or weight gain. Insulin resistance may be caused by obesity or viral infection, though is not confined to these conditions. Ultimately insulin resistance can progress to type II diabetes.
• Management of insulin resistance is primarily through changes in diet and levels of activity. However, similarly to obesity, maintaining these behavioural changes can be challenging.
• insulin resistance therapy with metformin or
• thiazolidinediones can lead to improvements in glycaemia, though efficacy is variable. Accordingly, there is a need for new therapies for treating insulin resistance, for example in type II diabetes patients.
• Muscle wasting is a common complication of many prevalent diseases (e.g. cancer, heart failure, chronic obstructive lung disease, kidney failure, stroke) and a prominent feature of aging. Muscle loss causes weakness and limits mobility, thereby burdening both caregivers and the health care system. Severe loss of muscle mass results in death. Muscle wasting is an independent predictor of mortality in many conditions regardless of disease severity.
• diseases e.g. cancer, heart failure, chronic obstructive lung disease, kidney failure, stroke
• Severe loss of muscle mass results in death.
• Muscle wasting is an independent predictor of mortality in many conditions regardless of disease severity.
• USPs are the largest subfamily of the deubiquitinating enzymes (DUBs) family with over 60 family members reported to date (Komander D. et ai, Nat Rev. Mol. (2009), 10, 550-563; Claque M. et ai, Physiol. Rev. (2013), 93, 1289-1315).
• USP19 is an important member due to its implications in pathological conditions including but not restricted to muscle atrophy disorders, cancer,
• USP19 expresses as multiple isoforms varying in length from 71.09 kDa (isoform 2) to 156.03 kDa (isoform 5) with the canonical sequence (isoform 1) of 145.65 kDa in size (uniprot.org).
• the cellular localisation of USP19 may be cytosolic or bound to the endoplasmic reticulum (Lee J. et ai., J. Biol. Chem. (2014), 289, 3510-3507; Lee J. et al., Nat. Cell Biol. (2016), 18, 765-776).
• USP19 is a key component of the endoplasmic reticulum-associated degradation (ERAD) pathway (Hassink B. et al., EMBO J. (2009), 10, 755-761 ; Lee J. et al., J. Biol. Chem. (2014), 289, 3510-3507; Lee J. et al., Nat. Cell Biol. (2016), 18, 765-776).
• ERAD endoplasmic reticulum-associated degradation
• USP19 is involved in the latter steps of the protein quality-control machinery rescuing ERAD substrates that have been retro-translocated to the cytosol.
• USP19 has also been demonstrated to regulate the stability of the E3 ligases MARCH6 and HRD1 (Nakamura N.
• USP19 has recently been implicated in the stabilisation of multiple and potentially important protein substrates. For instance, USP19 interacts with SIAH proteins to rescue HIF1a from degradation under hypoxic conditions (Altun M. et al., J. Biol. Chem. (2012), 287, 1962-1969; Velasco K. et ai, Biochem. Biophys. Res. Commun. (2013), 433, 390-395). USP19 also stabilises the KPC1 ubiquitin ligase which is involved in the regulation of the p27 Kip1 cyclin-dependent kinase inhibitor (Lu Y. et al., Mol. Cell Biol.
• USP19 negatively regulates type I IFN signalling pathway, by blocking RIG-I-MAVS interaction in a Beclin-1 dependent manner. Depletion of either USP19 or Beclin-1 inhibits autophagic flux and promotes type I IFN signalling as well as cellular antiviral immunity (Jin S. et al., EMBO J. (2016), 35, 866-880; Cui J. et al., Autophagy (2016), 12, 1210-1211). Recent findings also indicate USP19 may negatively affect the cellular antiviral type I IFN signalling by regulating the TRAF3 substrate (Gu Z. et al., Future Microbiol.
• USP19 has also been recently implicated in the Wnt signalling pathway by stabilising the coreceptor LRP6 (Perrody E. et al., eLife (2016), 5, e19083) and in the DNA repair processes, most particularly chromosomal stability and integrity, by regulating the HDAC1 and HDAC2 proteins (Wu M. et al., Oncotarget (2017), 8, 2197-2208).
• USP19 is also implicated in muscular atrophy, muscle-wasting syndromes and other skeletal muscle atrophy disorders (Wing S., Int. J. Biochem. Cell Biol. (2013), 45, 2130- 2135; Wing S. et aL, Int. J. Biochem. Cell Biol.
• USP19 KO mice In vivo studies have demonstrated that mice lacking the USP19 gene (USP19 KO mice) exhibited a decrease in fat mass when fed a high-fat diet (Coyne E, et al. Diabetologia. 2018 Nov 1. doi: 10.1007/s00125-018-4754-4., which is incorporated herein by reference). USP19 KO mice also exhibited greater glucose tolerance and higher insulin sensitivity when fed a high-fat diet.
• mice lacking the USP19 gene were resistant to muscle wasting in response to both glucocorticoids, a common systemic cause of muscle atrophy, as well as in response to denervation, a model of disuse atrophy (Bedard N. et al., FASEB J. (2015), 29, 3889-3898, which is incorporated herein by reference).
• pharmacological inhibitors of USP19 are an effective approach to the treatment of muscle- wasting conditions (e.g. cachexia and sarcopenia).
• USP19 inhibitors can reduce loss of muscle mass in an in vivo model of muscular atrophy.
• USP19 inhibitors can treat the symptoms of insulin resistance, as indicated by an improved response to glucose.
• WO2018/020242 provides for the first time a series of compounds which inhibit USP19, as determined by in vitro assay.
• the contents of WO2018/020242 are expressly incorporated herein by reference in its entirety, and particularly in relation to the compounds disclosed therein, their synthesis, methods of production and their in vitro inhibitory activity.
• the invention provides a compound, or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of therapy, wherein the compound is a compound according to formula (I):
• Ri is an optionally substituted alkyl, alkenyl, alkynyl, ether, cycloalkyl, alkylcycloalkyl, heterocycloalkyl, alkylheterocycloalkyl, aryl, arylalkyl, heteroaryl, or heteroarylalkyl group; R 2 is H or an optionally substituted alkyl group,
• R 3 IS H or an optionally substituted alkyl group
• R 4 is H or an optionally substituted alkyl group
• R 5 is H or an optionally substituted alkyl group
• R 2 and R 4 may be joined to one another to form an optionally substituted cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached
• R 4 and R 5 may be joined to one another to form an optionally substituted cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached;
• R 6 is H or an optionally substituted alkyl group
• W is C or N
• X is N or CRs, wherein Rs is H or optionally substituted C1-C6 alkyl,
• Y is N or CRg
• Z is CH, or NH
• Rg is H or optionally substituted alkyl, amido, amino, aryl, heteroaryl, cycloalkyl, cycloheteroalkyl, halo, carbonyl, ester, aminoalkyl, or cyano;
• R 7 is hydrogen, halo, or an optionally substituted alkyl, alkenyl, alkynyl, amino, aryl, cycloalkyl, cycloalkenyl, alkoxy, aryloxy, heteroaryl or heterocycloalkyl group; or the compound
• a compound as defined in relation to the first aspect or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of treating obesity.
• Also provided in accordance with the invention is a method of treating obesity comprising administering to a subject in need thereof an effective amount of a compound,
• a compound as defined in relation to the first aspect of the invention or a pharmaceutically acceptable salt, tautomer, stereoisomer or N- oxide derivative thereof, for use in a method of treating insulin resistance.
• Also provided in accordance with the invention is a method of treating insulin resistance comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• Also provided in accordance with the invention is a method of treating type II diabetes comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• a compound as defined in relation to the first aspect of the invention or a pharmaceutically acceptable salt, tautomer, stereoisomer or N- oxide derivative thereof, for use in a method of treating muscular atrophy.
• the invention provides a compound as defined in relation to the first aspect, or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of treating cachexia or sarcopenia.
• Also provided in accordance with the invention is a method of treating muscular atrophy comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• Also provided in accordance with the invention is a method of treating cachexia or sarcopenia comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• USP19 inhibitor compound as described in relation to the first aspect exhibit cell permeability and potent target engagement in cancer cell lines.
• the cell permeability and target engagement in cancer cells is comparable to that observed in muscle cells.
• USP19 inhibitors exhibit potent in vivo therapeutic effects on muscle wasting.
• pharmacological USP19 inhibitors will be effective at exerting therapeutic effects in cancer, due to the association of USP19 and oncogenic processes described above.
• a compound as defined in relation to the first aspect of the invention or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of treating cancer.
• Also provided in accordance with the invention is a method of treating cancer comprising administering to a subject in need thereof an effective amount of a compound,
• the cancer to be treated in accordance with the invention is breast cancer or neuroblastoma.
• a USP19 inhibitor for use in treating obesity In a further aspect is provided a USP19 inhibitor for use in treating muscular atrophy. In a further aspect is provided a USP19 inhibitor for use in treating type II diabetes. In a further aspect is provided a USP19 inhibitor for use in treating cancer.
• a method of treating cancer, obesity, insulin resistance, type II diabetes and/or muscular atrophy comprising administering to a subject in need thereof an effective amount of a USP19 inhibitor.
• Figure 1 Effect of USP19 pharmacological inhibition on tibialis anterior mass.
• Tibialis anterior mass (mg) from mice treated with vehicle or USP19 inhibitor compound ADC-141. Mass is given for the muscle from limb that had undergone sciatic nerve denervation (DEN) and also from the innervated limb (INN).
• B Percentage loss of tibialis anterior muscle mass as a result of denervation in vehicle and USP19 inhibitor (ADC-141) treated mice. Percentage calculated as a proportion of the mass of the muscle from the innervated limb of the same mouse.
• C Loss of tibialis anterior muscle mass (in mg) as a result of denervation in vehicle treated and USP19 inhibitor (ADC-141) treated mice. P ⁇ 0.025.
• Figure 2 Effect of USP19 pharmacological inhibition on gastrocnemius muscle mass.
• A gastrocnemius muscle mass (mg) from mice treated with vehicle or USP19 inhibitor compound ADC-141. Mass is given for the muscle from limb that had undergone sciatic nerve denervation (DEN) and also from the innervated limb (INN).
• B Percentage loss of gastrocnemius muscle mass as a result of denervation in vehicle and USP19 inhibitor (ADC-141) treated mice. Percentage calculated as a proportion of the mass of the muscle from the innervated limb of the same mouse.
• C Loss of gastrocnemius muscle mass (in mg) as a result of denervation in vehicle treated and USP19 inhibitor (ADC-141) treated mice.
• FIG. 3 (A) Effect of USP19 pharmacological inhibition on fat mass. The epididymal fat pad was collected from vehicle and USP19 inhibitor (ADC-141) treated mice, with USP19 inhibitor treated mice showing a significant reduction in fat mass. (B) Effect of USP19 pharmacological inhibition on liver mass. The liver was collected from vehicle and USP19 inhibitor (ADC-141) treated mice. An increase in liver mass was observed, likely due to accumulation of drug compound in the liver. (C) Percentage change in overall body weight in vehicle-treated control DIO mice.
• D Percentage change in overall lean mass
• E percentage change in overall fat mass in vehicle, USP19 inhibitor 5mg/kg, USP19 inhibitor 25mg/kg, and liraglutide treated mice (left to right, respectively).
• FIG. 4 Body composition analysis of mice in a dietary-induced obesity model, treated with USP19 inhibitor ACD-141 or liraglutide. All mice were fed a high-fat diet and treated as indicated. Results for total tissue mass, total body fat, and percentage body protein were determined. Percentage carcass ash was also determined. Means are adjusted for differences between treatment groups in Day 1 bodyweight. Error bars show SEM. *** pO.001 , ** pO.01.
• Figure 5 Cell target engagement of USP19 inhibitor compound in breast cancer, neuroblastoma and skeletal muscle cell lines. ECso was determined by densitometry.
• Figure 6 Response to oral glucose tolerance test (OGTT) in obese mice.
• A Timeline of plasma glucose response in vehicle-treated control mice (circles), USP19 inhibitor 5mg/kg ip BID (triangle), USP19 inhibitor 25mg/kg ip BID (solid circle), or positive control liraglutide 0.1 mg/kg sc BID (diamond);
• B Glucose AUC (mM.hr) and
• C insulin AUC (ng. hr/ml) for vehicle, USP19 inhibitor 5mg/kg, USP19 inhibitor 25mg/kg, and liraglutide (left to right, respectively). ** p ⁇ 0.01 vs vehicle; ***p ⁇ 0.001 vs vehicle.
• a USP19 inhibitor refers to a compound which acts on USP19 so as to decrease the activity of the enzyme.
• Examples of USP19 inhibitors are exemplified compounds herein.
• a USP19 inhibitor exhibits an I C50 of less than 5mM, preferably less than 0.5mM.
• “obesity” refers to the medical condition characterised by excess body fat.
• Obesity can be characterised by, for example, a body mass index (BMI) of greater than 30.
• BMI body mass index
• Treatment of obesity may be indicated by, for example, the reduction of body fat, in percentage and/or absolute mass terms. Treatment of obesity may also be exemplified by a reduction in the rate of body fat accumulation by a subject compared to before treatment.
• insulin resistance refers to the medical condition characterised by an abnormally weak response to insulin. Since insulin resistance is typically not treated by exogenous insulin treatment, the resistance is typically to insulin produced by the body of the subject, though the subject may also be resistant to exogenous insulin.“Insulin resistance” encompasses the conditions“prediabetes” and Type II diabetes. Insulin resistance may be indicated, for example, by a glucose tolerance test (GTT) glycaemia of 7.8 mmol/L or greater. Type II diabetes is typically diagnosed following a glucose tolerance test (GTT) glycaemia of 11.1 mmol/L or greater.
• GTT glucose tolerance test
• GTT glucose tolerance test
• Treatment of insulin resistance may be indicated by an improvement (i.e. reduction) in the subject’s GTT glycaemia compared to before treatment. Treatment may also be indicated by a reduction in the subject’s blood sugar concentration under normal conditions compared to before treatment.
• “muscular atrophy” and“muscle-wasting” are used interchangeably to refer to decrease in muscle mass in a subject, including in the context of cachexia or sarcopenia, for example. Muscular atrophy can be as a result of temporary or permanent disability, temporary or permanent immobilisation of a limb, extended bedrest, cachexia (for example as a result of cancer, heart failure, or COPD), or sarcopenia.
• Treatment of muscular atrophy may be characterised as the slowing of the rate of atrophy - that is, treatment results in less muscle mass lost over a given period of time. Preferably, successful treatment results in no loss of muscle mass.
• alkyl group (alone or in combination with another term(s)) means a straight-or branched-chain saturated hydrocarbon substituent typically containing 1 to 15 carbon atoms, such as 1 to 10, 1 to 8, 1 to 6, or 1 to 4 carbon atoms.
• A“C n alkyl” group refers to an aliphatic group containing n carbon atoms.
• a C1-C10 alkyl group contains 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms. Attachment to the alkyl group occurs through a carbon atom.
• substituents include methyl, ethyl, n-propyl, isopropyl, n- butyl, isobutyl, sec-butyl, tert- butyl, pentyl (branched or unbranched), hexyl (branched or unbranched), heptyl (branched or unbranched), octyl (branched or unbranched), nonyl (branched or unbranched), and decyl (branched or unbranched).
• alkenyl group means a straight-or branched-chain hydrocarbon substituent containing one or more double bonds and typically 2 to 15 carbon atoms; such as 2 to 10, 2 to 8, 2 to 6 or 2 to 4 carbon atoms.
• substituents include ethenyl (vinyl), 1-propenyl, 3-propenyl, 1 ,4-pentadienyl, 1 ,4- butadienyl, 1-butenyl, 2-butenyl, 3-butenyl, pentenyl and hexenyl.
• alkynyl group (alone or in combination with another term(s)) means a straight-or branched-chain hydrocarbon substituent containing one or more triple bonds and typically 2 to 15 carbon atoms; such as 2 to 10, 2 to 8, 2 to 6 or 2 to 4 carbon atoms.
• substituents include ethynyl, 1-propynyl, 3-propynyl, 1-butynyl, 3-butynyl and 4- butynyl.
• heteroalkyl group (alone or in combination with another term(s)) means a straight-or branched-chain saturated hydrocarbyl substituent typically containing 1 to 15 atoms, such as 1 to 10, 1 to 8, 1 to 6, or 1 to 4 atoms, wherein at least one of the atoms is a heteroatom (i.e. oxygen, nitrogen, or sulfur), with the remaining atoms being carbon atoms.
• A“C n heteroalkyl” group refers to an aliphatic group containing n carbon atoms and one or more heteroatoms, for example one heteroatom.
• a C1-C10 heteroalkyl group contains 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms in addition to one or more heteroatoms, for example one heteroatom. Attachment to the heteroalkyl group occurs through a carbon atom or through a heteroatom.
• heteroalkenyl group (alone or in combination with another term(s)) means a straight-or branched-chain hydrocarbon substituent containing one or more carbon-carbon double bonds and typically 2 to 15 atoms; such as 2 to 10, 2 to 8, 2 to 6 or 2 to 4 atoms, wherein at least one of the atoms is a heteroatom (i.e. oxygen, nitrogen, or sulfur), with the remaining atoms being carbon atoms.
• A“C n heteroalkenyl” group refers to an aliphatic group containing n carbon atoms and one or more heteroatoms, for example one heteroatom.
• a C2-C10 heteroalkenyl group contains 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms in addition to one or more heteroatoms, for example one heteroatom.
• Attachment to the heteroalkenyl group occurs through a carbon atom or through a heteroatom.
• heteroalkynyl group (alone or in combination with another term(s)) means a straight-or branched-chain hydrocarbon substituent containing one or more carbon-carbon triple bonds and typically 2 to 15 carbon atoms; such as 2 to 10, 2 to 8, 2 to 6 or 2 to 4 carbon atoms, wherein at least one of the atoms is a heteroatom (i.e. oxygen, nitrogen, or sulfur), with the remaining atoms being carbon atoms.
• A“C n heteroalkynyl” group refers to an aliphatic group containing n carbon atoms and one or more heteroatoms, for example one heteroatom.
• a C2-C10 heteroalkynyl group contains 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms in addition to one or more heteroatoms, for example one heteroatom. Attachment to the heteroalkynyl group occurs through a carbon atom or through a heteroatom.
• carbocyclyl group (alone or in combination with another term(s)) means a saturated cyclic (i.e. "cycloalkyl"), partially saturated cyclic (i.e. “cycloalkenyl”), or completely unsaturated (i.e. "aryl”) hydrocarbon substituent containing from 3 to 14 carbon ring atoms ("ring atoms” are the atoms bound together to form the ring or rings of a cyclic substituent).
• a carbocyclyl may be a single-ring (monocyclic) or polycyclic ring structure.
• a carbocyclyl may be a single ring structure, which typically contains 3 to 8 ring atoms, more typically 3 to 7 ring atoms, and more typically 5 to 6 ring atoms.
• Examples of such single-ring carbocyclyls include cyclopropyl (cyclopropanyl), cyclobutyl (cyclobutanyl), cyclopentyl (cyclopentanyl), cyclopentenyl, cyclopentadienyl, cyclohexyl (cyclohexanyl), cyclohexenyl, cyclohexadienyl, and phenyl.
• a carbocyclyl may alternatively be polycyclic (i.e. may contain more than one ring).
• polycyclic carbocyclyls include bridged, fused, and spirocyclic carbocyclyls.
• a spirocyclic carbocyclyl one atom is common to two different rings.
• An example of a spirocyclic carbocyclyl is spiropentanyl.
• a bridged carbocyclyl the rings share at least two common non-adjacent atoms.
• bridged carbocyclyls include bicyclo[2.2.1]heptanyl, bicyclo[2.2.1]hept-2-enyl, and adamantanyl.
• two or more rings may be fused together, such that two rings share one common bond.
• Examples of two- or three-fused ring carbocyclyls include naphthalenyl, tetrahydronaphthalenyl (tetralinyl), indenyl, indanyl (dihydroindenyl), anthracenyl, phenanthrenyl, and decalinyl.
• cycloalkyl group (alone or in combination with another term(s)) means a saturated cyclic hydrocarbon substituent containing 3 to 14 carbon ring atoms.
• a cycloalkyl may be a single carbon ring, which typically contains 3 to 8 carbon ring atoms and more typically 3 to 6 ring atoms. It is understood that attachment to a cycloalkyl group is via a ring atom of the cycloalkyl group.
• single-ring cycloalkyls include cyclopropyl, cyclobutyl, cyclopentyl, and cyclohexyl.
• a cycloalkyl may alternatively be polycyclic or contain more than one ring.
• Polycyclic cycloalkyls include bridged, fused, and spirocyclic cycloalkyls.
• alkylcycloalkyl refers to a cycloalkyl substituent attached via an alkyl chain.
• alkylcycloalkyl substitent include cyclohexylethane, where the cyclohexane is attached via an ethane linker.
• Other examples include cyclopropylethane,
• C n includes the carbon atoms in the alkyl chain and in the cycloalkyl ring.
• cyclohexylethane is a C8 alkylcycloalkyl.
• aryl group (alone or in combination with another term(s)) means an aromatic carbocyclyl containing from 5 to 14 carbon ring atoms, optionally 5 to 8, 5 to 7, optionally 5 to 6 carbon ring atoms.
• A“C n aryl” group refers to an aromatic group containing n carbon atoms.
• a C6-C10 aryl group contains 6, 7, 8, 9 or 10 carbon atoms.
• Attachment to the aryl group occurs through a carbon atom.
• An aryl group may be monocyclic or polycyclic (i.e. may contain more than one ring). In the case of polycyclic aromatic rings, only one ring in the polycyclic system is required to be unsaturated while the remaining ring(s) may be saturated, partially saturated or unsaturated. Attachment to the aryl group occurs through a carbon atom contained in the ring. Examples of aryl groups include phenyl, naphthyl, acridinyl, indenyl, indanyl, and tetrahydronapthyl.
• arylalkyl refers to an aryl substituent attached via an alkyl chain.
• Examples of an arylalkyl substitent include phenylethane/ethylbenzene, where the ethane chain links to a phenyl group to the point of attachment.
• C n includes the carbon atoms in the alkyl chain and in the aryl group.
• ethylbenzene is a C8 arylalkyl.
• heterocyclyl group (alone or in combination with another term(s)) means a saturated (i.e. "heterocycloalkyl"), partially saturated (i.e. “heterocycloalkenyl”), or completely unsaturated (i.e. "heteroaryl”) ring structure containing a total of 3 to 14 ring atoms, wherein at least one of the ring atoms is a heteroatom (i.e. oxygen, nitrogen, or sulfur), with the remaining ring atoms being carbon atoms.
• a heterocyclyl group may, for example, contain one, two, three, four or five heteroatoms. Attachment to the heterocyclyl group may occur through a carbon atom and/or one or more heteroatoms that are contained in the ring.
• a heterocyclyl may be a single-ring (monocyclic) or polycyclic ring structure.
• a heterocyclyl group may be a single ring, which typically contains from 3 to 7 ring atoms, more typically from 3 to 6 ring atoms, and even more typically 5 to 6 ring atoms.
• single-ring heterocyclyls include furanyl, dihydrofuranyl, tetrahydrofuranyl, thiophenyl (thiofuranyl), dihydrothiophenyl, tetrahydrothiophenyl, pyrrolyl, pyrrolinyl, pyrrolidinyl, imidazolyl, imidazolinyl, imidazolidinyl, pyrazolyl, pyrazolinyl, pyrazolidinyl, triazolyl, tetrazolyl, oxazolyl, oxazolidinyl, isoxazolidinyl, isoxazolidinyl, isoxazolidinyl, isoxazolyl, thiazolyl, iso
• tetrahydrothiopyranyl pyridinyl (azinyl), piperidinyl, diazinyl (including pyridazinyl (1 ,2- diazinyl), pyrimidinyl (1 ,3-diazinyl) or pyrazinyl (1 ,4-diazinyl)), piperazinyl, triazinyl
• a heterocyclyl group may alternatively be polycyclic (i.e. may contain more than one ring).
• polycyclic heterocyclyl groups include bridged, fused, and spirocyclic heterocyclyl groups.
• a spirocyclic heterocyclyl group one atom is common to two different rings.
• a bridged heterocyclyl group the rings share at least two common non- adjacent atoms.
• two or more rings may be fused together, such that two rings share one common bond.
• fused ring heterocyclyl groups containing two or three rings include indolizinyl, pyranopyrrolyl, 4/-/-quinolizinyl, purinyl, naphthyridinyl, pyridopyridinyl (including pyrido[3,4-b]-pyridinyl, pyrido[3,2-b]- pyridinyl, or pyrido[4,3-b]-pyridinyl), and pteridinyl.
• fused-ring heterocyclyl groups containing two or three rings include indolizinyl, pyranopyrrolyl, 4/-/-quinolizinyl, purinyl, naphthyridinyl, pyridopyridinyl (including pyrido[3,4-b]-pyridinyl, pyrido[3,2-b]- pyridinyl, or pyrido[4,3-b]-pyr
• heterocyclyl groups include benzo-fused heterocyclyl groups, such as indolyl, isoindolyl (isobenzazolyl, pseudoisoindolyl), indoleninyl (pseudoindolyl), isoindazolyl (benzpyrazolyl), benzazinyl (including quinolinyl (1-benzazinyl) or isoquinolinyl (2-benzazinyl)), phthalazinyl, quinoxalinyl, quinazolinyl, benzodiazinyl (including cinnolinyl (1 ,2-benzodiazinyl) or quinazolinyl (1 ,3-benzodiazinyl)), benzopyranyl (including chromanyl or isochromanyl), and benzisoxazinyl (including 1 ,2-benzisoxazinyl or 1 ,4-benzisoxazinyl).
• indolyl iso
• heterocycloalkyl group (alone or in combination with another term(s)) means a saturated heterocyclyl.
• A“C n heterocycloalkyl” group refers to a cyclic aliphatic group containing n carbon atoms in addition to at least one heteroatom, for example nitrogen.
• a C1-C10 heterocycloalkyl group contains 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon ring atoms in addition to the at least one heteroatom. Attachment to the heterocycloalkyl group occurs through a carbon atom or one of the at least one heteroatoms.
• alkylheterocycloalkyl refers to a heterocycloalkyl substituent attached via an alkyl chain.
• C n includes the carbon atoms in the alkyl chain and in the heterocycloalkyl ring.
• ethylpiperidine is a C7 alkylheterocycloalkyl.
• heteroaryl group (alone or in combination with another term(s)) means an aromatic heterocyclyl containing from 5 to 14 ring atoms.
• A“C n heteroaryl” group refers to an aromatic group containing n carbon atoms and at least one heteroatom.
• a C2-C10 aryl group contains 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms in addition to at least one heteroatom. Attachment to the heteroaryl group occurs through a carbon atom or through a heteroatom.
• a heteroaryl group may be monocyclic or polycyclic.
• a heteroaryl may be a single ring or 2 or 3 fused rings.
• Examples of monocyclic heteroaryl groups include 6-membered rings such as pyridyl, pyrazinyl, pyrimidinyl, pyridazinyl, and 1 ,3,5-, 1 ,2,4- or 1 ,2,3-triazinyl; 5-membered rings such as imidazolyl, furanyl, thiophenyl, pyrazolyl, oxazolyl, isoxazolyl, thiazolyl, 1 ,2,3-, 1 ,2,4-, 1 ,2,5-, or 1 ,3,4-oxadiazolyl and isothiazolyl.
• Polycyclic heteroaryl groups may be 2 or 3 fused rings.
• polycyclic heteroaryl groups examples include 6/5-membered fused ring groups such as benzothiofuranyl, benzisoxazolyl, benzoxazolyl, and purinyl; and 6/6-membered fused ring groups such as benzopyranyl, quinolinyl, isoquinolinyl, cinnolinyl, quinazolinyl, and benzoxazinyl.
• 6/5-membered fused ring groups such as benzothiofuranyl, benzisoxazolyl, benzoxazolyl, and purinyl
• 6/6-membered fused ring groups such as benzopyranyl, quinolinyl, isoquinolinyl, cinnolinyl, quinazolinyl, and benzoxazinyl.
• polycyclic heteroaryl groups only one ring in the polycyclic system is required to be unsaturated while the remaining ring(s) may be saturated, partially
• a nitrogen-containing heteroaryl group is a heteroaryl group in which at least one of the one or more heteroatoms in the ring is nitrogen.
• heteroarylalkyl refers to a heteroaryl substituent attached via an alkyl chain.
• heteroarylalkyl substitent include ethylpyridine, where the ethane chain links a pyridine group to the point of attachment.
• amino group refers to the -NR’R” group.
• the amino group can be optionally substituted.
• R’ and R are hydrogen.
• R’ and R each independently may be, but are not limited to, hydrogen, an alkyl, heteroalkyl, cycloalkyl, heterocycloalkyl, alkylcycloalkyl, alkylheterocycloalkyl, alkoxy, sulfonyl, alkenyl, alkanoyl, aryl, arylalkyl, or a heteroaryl group, provided R’ and R” are not both hydrogen.
• R’ and R may cyclise to form a cyclic amino group, e.g. a pyrrolidine group or a piperidine group.
• a cyclic amino group may incorporate other heteroatoms, for example to form a piperazine or morpholine group.
• Such a cyclic amino group may be optionally substituted, e.g. with an amino group, a hydroxyl group or an oxo group.
• aminoalkyl refers to the -R a NR’R” group, wherein R a is an alkyl chain as defined above and NR’R” is an optionally substituted amino group as defined above.
• C n aminoalkyl refers to a group containing n carbon atoms.
• a C1-C10 aminoalkyl group contains 1 , 2, 3, 4, 5, 6, 7, 8, 9 or 10 carbon atoms.
• the amino group of the aminoalkyl group is a substituted amino group, the number of carbon atoms includes any carbon atoms in the substituent groups. Attachment to the aminoalkyl group occurs through a carbon atom of the R a alkyl group.
• aminoalkyl substituents include methylamine, ethylamine, methylaminomethyl, dimethylaminomethyl,
• ether refers to an an -O-alkyl group or an -alkyl-O-alkyl group, for example a methoxy group, a methoxymethyl group or an ethoxyethyl group.
• the alkyl chain(s) of an ether can be linear, branched or cyclic chains.
• the ether group can be optionally substituted (a "substituted ether") with one or more substituents.
• a C n ether refers to an ether group having n carbons in all alkyl chains of the ether group. For example, a
• CH(CH3)-0-C6H11 ether is a Cs ether group.
• alkoxy group refers to an -O-alkyl group.
• the alkoxy group can refer to linear, branched, or cyclic, saturated or unsaturated oxy-hydrocarbon chains, including, for example, methoxyl, ethoxyl, propoxyl, isopropoxyl, butoxyl, f-butoxyl and pentoxyl.
• the alkoxy group can be optionally substituted (a "substituted alkoxy") with one or more alkoxy group substituents.
• aryloxy group refers to an -O-aryl group, for example a phenoxy group.
• An aryloxy substituent may itself be optionally substituted, for example with a halogen.
• alkylester refers to a -C(0)OR group, where R is an alkyl group as defined herein.
• R is an alkyl group as defined herein.
• An example of an alkylester is ethyl methanoate - i.e. R is an ethyl group.
• hydroxyl refers to an -OH group.
• halo group refers to a group selected from chlorine, fluorine, bromine and iodine.
• the halo group is selected from chlorine and fluorine.
• An alkyl, alkenyl, alkynyl, carbocyclyl (including cycloalkyl, cycloalkenyl and aryl), heterocyclyl (including heterocycloalkyl, heterocyloalkenyl, heteroaryl, nitrogen-containing heterocyclyl), amino, amido, ester, ether, alkoxy, or sulfonamide group can be optionally substituted with one or more substituents, which can be the same or different.
• a substituent can be attached through a carbon atom and/or a heteroatom in the alkyl, alkenyl, alkynyl, carbocyclyl (including cycloalkyl, cycloalkenyl and aryl), heterocyclyl (including
• heterocycloalkyl heterocyloalkenyl, heteroaryl, nitrogen-containing heterocyclyl, nitrogen- containing heteroaryl), amino, amido, ester, ether, alkoxy, or sulfonamide group.
• substituted alkyl substituted alkyl, heteroalkyl, substituted heteroalkyl, aralkyl, substituted aralkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, halo, hydroxyl, cyano, amino, amido, alkylamino, arylamino, carbocyclyl, cycloalkyl, substituted cycloalkyl, heterocycloalkyl, substituted
• heterocycloalkyl cycloalkenyl, substituted cycloalkenyl, aryl, substituted aryl, heteroaryl, substituted heteroaryl, nitro, thio, alkanoyl, hydroxyl, aryloxyl, alkoxyl, alkylthio, arylthio, aralkyloxyl, aralkylthio, carboxyl, alkoxycarbonyl, oxo, alkylsulfonyl, arylsulfonyl and sulfoximinyl.
• the substituent is alkyl, substituted alkyl, heteroalkyl, substituted heteroalkyl, alkenyl, substituted alkenyl, alkynyl, substituted alkynyl, halo, hydroxyl, cyano, amino, amido, alkylamino, arylamino, carbocyclyl, cycloalkyl, substituted cycloalkyl, heterocycloalkyl, substituted heterocycloalkyl, cycloalkenyl, substituted cycloalkenyl, aryl, substituted aryl, heteroaryl, substituted heteroaryl, nitro, thio, alkanoyl, hydroxyl, aryloxyl, alkoxyl, alkylthio, arylthio, aralkyloxyl, aralkylthio, carboxyl, alkoxycarbonyl, oxo, alkylsulfonyl and arylsulfonyl.
• a group for example an alkyl group, is“optionally substituted”, it is understood that the group has one or more substituents attached (substituted) or does not have any
• first substituent may itself be either unsubstituted or substituted.
• the compounds of the present invention may possess some aspect of stereochemistry.
• the compounds may possess chiral centres and/or planes and/or axes of symmetry.
• the compounds may be provided as single
• Stereoisomers are known in the art to be molecules that have the same molecular formula and sequence of bonded atoms, but which differ in their spatial orientations of their atoms and/or groups.
• the compounds of the present invention may exhibit tautomerism. Each tautomeric form is intended to fall within the scope of the invention.
• the compounds of the present invention may be provided as a pro-drug.
• Pro drugs are transformed, generally in vivo, from one form to the active forms of the drugs described herein.
• a hydrogen atom may be 1 H, 2 H (deuterium) or 3 H (tritium).
• the compounds of the present invention may be provided in the form of their pharmaceutically acceptable salts or as co-crystals.
• pharmaceutically acceptable salt refers to ionic compounds formed by the addition of an acid to a base.
• the term refers to such salts that are considered in the art as being suitable for use in contact with a patient, for example in vivo and pharmaceutically acceptable salts are generally chosen for their non-toxic, non-irritant characteristics.
• co-crystal refers to a multi- component molecular crystal, which may comprise non-ionic interactions.
• compositions may be prepared by ion exchange chromatography or by reacting the free base or acidic form of a compound with
• Salts known in the art to be generally suitable for use in contact with a patient include salts derived from inorganic and/or organic acids, including the hydrobromide, hydrochloride, sulfate, bisulfate, nitrate, acetate, oxalate, oleate, palmitate, stearate, laurate, benzoate, lactate, phosphate, tosylate, citrate, maleate, fumarate, succinate and tartrate. These may include cations based on the alkali and alkaline earth metals, such as sodium, potassium, calcium and magnesium, as well as ammonium, tetramethylammonium,
• the compounds for use in accordance with the present invention may sometimes exist as zwitterions, which are considered as part of the invention.
• the invention provides a compound, or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of therapy, wherein the compound is a compound according to formula (I):
• Ri is an optionally substituted alkyl, alkenyl, alkynyl, ether, cycloalkyl, alkylcycloalkyl, heterocycloalkyl, alkylheterocycloalkyl, aryl, arylalkyl, heteroaryl, or heteroarylalkyl group; R2 is H or an optionally substituted alkyl group,
• R3 IS H or an optionally substituted alkyl group
• R4 is H or an optionally substituted alkyl group
• R5 is H or an optionally substituted alkyl group
• R2 and R4 may be joined to one another to form an optionally substituted cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached
• R4 and R5 may be joined to one another to form an optionally substituted cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached;
• R6 is H or an optionally substituted alkyl group
• W is C or N
• X is N or CRs, wherein Rs is H or optionally substituted C1-C6 alkyl,
• Y is N or CRg
• Z is CH, or NH
• Rg is H or optionally substituted alkyl, amido, amino, aryl, heteroaryl, cycloalkyl, cycloheteroalkyl, halo, carbonyl, ester, aminoalkyl, or cyano;
• R7 is hydrogen, halo, or an optionally substituted alkyl, alkenyl, alkynyl, amino, aryl, cycloalkyl, cycloalkenyl, alkoxy, aryloxy, heteroaryl or heterocycloalkyl group; or the compound
• the data provided herein is the first demonstration that pharmacological inhibition of USP19 can reduce fat accumulation in a wild-type background. Taken together, the in vitro and in vivo data demonstrate that compounds which potently inhibit USP19 activity can effectively treat obesity.
• a USP19 inhibitor for use in a method of treating obesity.
• a compound as defined in relation to the first aspect or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of treating obesity.
• Also provided in accordance with the invention is a method of treating obesity comprising administering to a subject in need thereof an effective amount of a compound,
• a USP19 inhibitor for use in a method of treating insulin resistance.
• a USP19 inhibitor for use in a method of treating type II diabetes.
• Also provided in accordance with the invention is a method of treating insulin resistance comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• Also provided in accordance with the invention is a method of treating type II diabetes comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• a USP19 inhibitor for use in a method of treating muscular atrophy.
• a compound as defined in relation to the first aspect of the invention or a pharmaceutically acceptable salt, tautomer, stereoisomer or N- oxide derivative thereof, for use in a method of treating muscular atrophy.
• the invention provides a compound as defined in relation to the first aspect, or a pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof, for use in a method of treating cachexia or sarcopenia.
• Also provided in accordance with the invention is a method of treating muscular atrophy comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• Also provided in accordance with the invention is a method of treating cachexia or sarcopenia comprising administering to a subject in need thereof an effective amount of a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention, or an effective amount of a pharmaceutical composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined in relation to the first aspect of the invention.
• the compound (or pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative thereof) for use in methods of therapy according to the invention is a compound according to formula (I):
• Ri is an optionally substituted alkyl, alkenyl, alkynyl, ether, cycloalkyl, alkylcycloalkyl, heterocycloalkyl, alkylheterocycloalkyl, aryl, arylalkyl, heteroaryl, or heteroarylalkyl group;
• R 2 is H or an optionally substituted alkyl group
• R 3 IS H or an optionally substituted alkyl group
• R 4 is H or an optionally substituted alkyl group
• R 5 is H or an optionally substituted alkyl group
• R 2 and R 4 may be joined to one another to form an optionally substituted cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached
• R 4 and R 5 may be joined to one another to form an optionally substituted cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached;
• R 6 is H or an optionally substituted alkyl group
• W is C or N
• X is N or CRs, wherein Rs is H or optionally substituted C1-C6 alkyl,
• Y is N or CRg
• Z is CH, or NH
• Rg is H or optionally substituted alkyl, amido, amino, aryl, heteroaryl, cycloalkyl, cycloheteroalkyl, halo, carbonyl, ester, aminoalkyl, or cyano;
• R 7 is hydrogen, halo, or an optionally substituted alkyl, alkenyl, alkynyl, amino, aryl, cycloalkyl, cycloalkenyl, alkoxy, aryloxy, heteroaryl or heterocycloalkyl group; or the compound
• Ri is optionally substituted C1-C6 alkyl, optionally substituted C4-C10 alkylcycloalkyl, optionally substituted C7-C10 arylalkyl, optionally substituted C3-C6 cycloalkyl, optionally substituted C4-C5 heterocycloalkyl, or optionally substituted C3-C6 heteroaryl,
• each optional substituent is independently selected from C1-C6 alkyl, C2- C6 alkenyl, hydroxymethyl, methoxymethyl, benzyloxy methyl, phenyl, C3-C6 cycloalkyl, CFs, CHF 2 , OH, or halo.
• Ri is optionally substituted C7-C10 cyclohexylalkane, optionally substituted C4-C6 cyclopropylalkane, optionally substituted C5-C6 cyclobutylalkane, optionally substituted C7-C10 alkylbenzene, optionally substituted 2,2 difluorobutane, or optionally substituted 3,3,3-trifluoropropane, wherein each optional substituent is independently selected from C1-C6 alkyl, C2- C6 alkenyl, hydroxymethyl, hydroxyethyl, methoxymethyl, OH, or halo.
• Ri is substituted and the substituent is C1-C6 alkyl, optionally methyl.
• Ri is methyl substituted cyclohexylethane or methyl substituted ethylbenzene.
• Ri is:
• Ri is:
• Ri is methyl substituted 2,2 difluorobutane, or methyl substituted 3,3,3-trifluoropropane.
• Ri is:
• Ri is:
• Ri is C4-C5 heterocycloalkyl, optionally substituted with phenyl.
• Ri is phenyl-substituted pyrrolidine or phenyl-substituted piperidine. In certain preferred embodiments, Ri forms the following group together with the carbonyl to which it is attached:
• Ri forms the following group together with the carbonyl to which it is attached:
• Ri forms the following group together with the carbonyl to which it is attached:
• Ri forms the following group together with the carbonyl to which it is attached:
• Ri forms the following group together with the carbonyl to which it is attached:
• R 7 is optionally substituted C6-C10 aryl, C1-C12 heteroaryl, C1-C10 alkyl, C2-C10 alkenyl, C3-C10 cycloalkyl, amino, C1-C3 alkoxy, or halo,
• the optional substituent is selected from C1-C6 alkyl, hydroxysubstituted C1-C6 alkyl, C3-C6 cycloalkyl, C1-C6 heterocycloalkyl, C1-C6 alkoxy, halo-substituted C1- C6 alkoxy, amido, cyano or halo.
• R 7 is cyclopropyl, thiophene, or optionally substituted phenyl
• the optional substituent is selected from C1-C6 alkyl, hydroxysubstituted C1-C6 alkyl, C1-C6 alkylamine, and halo.
• R 7 is phenyl
• R 7 is fluoro-substituted phenyl.
• the phenyl has a single fluoro substituent.
• the fluoro substituent is in the ortho or meta position,
• R 2 , R 3 , R 4 , Rs are independently selected from H and C1-C6 alkyl.
• R 2 and R 3 are H, and R 4 and R 5 are methyl.
• R 4 and R 5 are joined to one another to form an optionally substituted C3-C6 cycloalkyl or C3-C6 heterocycloalkyl that includes the carbon to which they are attached and R 2 and R 3 are independently selected from H and C1-C6 alkyl.
• R 2 and R 3 are H and R 4 and R 5 are joined to one another to form a C3-C6 cycloalkyl that includes the carbon to which they are attached.
• R4 and R5 are joined to one another to form a C4 cycloalkyl that includes the carbon to which they are attached.
• R4 and R5 are joined to one another to form a C5 cycloalkyl that includes the carbon to which they are attached.
• R6 is H or C1-C6 alkyl.
• R2 and R4 are joined to one another to form a C5 cycloalkyl that includes the carbons to which they are attached, and wherein R3, Rs and R 6 are
• W is N and X is CRs, wherein Rs is H or methyl.
• Y is N or CRg, wherein Rg is H, C1-C6 alkyl, NR’R”, C(0)NR’R”, cyano, carboxyl, halo, C1-C6 alkylamine, C3-C6 alkylester, optionally substituted C6-C10 aryl or optionally substituted C2-C6 heteroaryl, wherein the one or more heteroatoms are selected from N and O, and the one or more optional substituents of the aryl or heteroaryl are selected from C1-C6 alkyl, C1-C6 alkylamine, amido, and cyano, wherein R’ and R” are independently selected from H, C1-C6 alkyl optionally substituted with OH, C3-C7 cycloalkyl, C1-C7 heterocycloalkyl, C4-C7 alkylcycloalkyl, C3- C7 alkylheterocycloalkyl, benzyl, phenyl, pheny
• Y is N or CRg, wherein Rg is selected from: phenyl optionally substituted with amido, cyano or methyl amine; pyridine; oxazole; pyrazole; carboxyl; C(0)NR’R”; or NR’R”;
• R’ and R are independently selected from H, C1-C6 alkyl, C3-C7 cycloalkyl, C3-C7 heterocycloalkyl wherein the heteroatom is N or O, or wherein R’ and R” are joined to one another to form a C2-C7 heterocycloalkyl that includes the N to which they are attached, wherein the heterocycloalkyl is optionally hydroxyl-substituted, oxo- substituted, methyl-substituted, CH20H-substituted, or acetyl-substituted.
• Ri is selected from optionally substituted ethylcyclohexane, optionally substituted ethylbenzene, optionally substituted 2,2 difluorobutane, and optionally substituted 3,3,3- trifluoropropane, wherein the optional substituent is one or more of methyl, ethyl, propyl, propenyl, hydroxymethyl and methoxymethyl, or wherein Ri is phenyl-substituted pyrrolidine,
• R2 and R3 are independently selected from H, methyl,
• R4 and R5 are independently selected from H, methyl, or are joined to one another to form a C3-C6 cycloalkyl or heterocycloalkyl that includes the carbon to which they are attached, optionally a C4 or C5 cycloalkyl that includes the carbon to which they are attached
• R6 is H or methyl
• R7 is selected from optionally substituted phenyl, indazole, thiophene, or pyrazole, wherein the optional substituent is selected from C1-C6 alkyl, hydroxysubstituted C1-C6 alkyl, C3-C6 cycloalkyl, C1-C6 heterocycloalkyl, C1-C6 alkoxy, halo-substituted C1-C6 alkoxy, C1-C6 alkylamine, amido, cyano or halo,
• W is N or C
• X is CH or N
• Z is C or NH
• Y is N or CRg, wherein Rg is selected from: phenyl optionally substituted with amido, cyano or methyl amine; pyridine; oxazole; pyrazole; C(0)NR’R”; or NR’R”;
• R’ and R are independently selected from H, C1-C6 alkyl, C3-C7 cycloalkyl, C3-C7 heterocycloalkyl wherein the heteroatom is N or O, or wherein R’ and R” are joined to one another to form a C2-C7 heterocycloalkyl that includes the N to which they are attached, wherein the heterocycloalkyl is optionally hydroxyl-substituted, oxo- substituted, methyl-substituted, hydroxymethyl-substituted, or acetyl-substituted.
• Y is CRg, wherein Rg is C(0)NR’R” and wherein R’ and R” are joined to one another to form an optionally substituted pyrrolidine, piperidine, piperazine or morpholine that includes the N to which they are attached, wherein the piperidine, pyrrolidine, piperazine or morpholine is optionally hydroxyl-substituted, oxo-substituted, methyl-substituted, hydroxymethyl-substituted, or acetyl-substituted.
• Y is CRg, wherein Rg is C(0)NR’R” and wherein R’ and R” are joined to one another to form a piperazinyl ring.
• W is N and Y is N, such that the ring comprising W, X, Y, Z is a substituted pyrimidinone ring.
• the compound for use in the methods of treatment in accordance with the invention is the compound of Example 212 herein: 1-(((S)-7-((R)-3- Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenyl-5- (piperazine-1-carbonyl)pyridin-2(1 H)-one:
• This compound and its synthesis is provided as Example 212 of WO2018/020242 (page 217), which is expressly incorporated herein by reference.
• the present invention provides a pharmaceutical composition for use in a method of therapy, the pharmaceutical composition comprising a compound,
• composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined herein, for use in a method of treating muscular atrophy.
• composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined herein, for use in a method of obesity.
• composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined herein, for use in a method of treating insulin resistance.
• composition comprising a compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative as defined herein, for use in a method of treating type II diabetes.
• the pharmaceutical composition for use in methods of the invention further comprises a pharmaceutically acceptable diluent, excipient or carrier.
• compositions may be formulated according to their particular use and purpose by mixing, for example, excipient, binding agent, lubricant, disintegrating agent, coating material, emulsifier, suspending agent, solvent, stabilizer, absorption enhancer and/or ointment base.
• the composition may be suitable for oral, injectable, rectal or topical administration.
• Suitable pharmaceutically acceptable excipients would be known by the person skilled in the art, for example: fats, water, physiological saline, alcohol (e.g. ethanol), glycerol, polyols, aqueous glucose solution, extending agent, disintegrating agent, binder, lubricant, wetting agent, stabilizer, emulsifier, dispersant, preservative, sweetener, colorant, seasoning agent or aromatizer, concentrating agent, diluent, buffer substance, solvent or solubilizing agent, chemical for achieving storage effect, salt for modifying osmotic pressure, coating agent or antioxidant, saccharides such as lactose or glucose; starch of corn, wheat or rice; fatty acids such as stearic acid; inorganic salts such as magnesium metasilicate aluminate or anhydrous calcium phosphate; synthetic polymers such as polyvinylpyrrolidone or polyalkylene glycol; alcohols such as stearyl alcohol or benzyl alcohol; synthetic
• a sterile aqueous solution may be provided that may contain other substances including, for example, salts and/or glucose to make to solution isotonic.
• the pharmaceutical composition may be administered orally, such as in the form of tablets, coated tablets, hard or soft gelatine capsules, solutions, emulsions, or suspensions. Administration can also be carried out rectally, for example using
• suppositories locally or percutaneously, for example using ointments, creams, gels or solution, or parenterally, for example using injectable solutions.
• the compounds of the present invention may be admixed with pharmaceutically inert, inorganic or organic excipients.
• suitable excipients include lactose, mize starch or derivatives thereof, talc or stearic acid or salts thereof.
• suitable excipients for use with soft gelatine capsules include, for example, vegetable oils, waxes, fats and semi-solid or liquid polyols.
• excipients include, for example, water, polyols, saccharose, invert sugar and glucose.
• excipients include, for example, water, alcohols, polyols, glycerine and vegetable oil.
• excipients include, for example, natural or hardened oils, waxes, fats and semi-solid or liquid polyols.
• the pharmaceutical compositions may also contain preserving agents, solublizing agents, stabilizing agents, wetting agents, emulsifiers, sweeteners, colorants, odorants, buffers, coating agents and/or antioxidants.
• the second drug may be provided in pharmaceutical composition with the present invention or may be provided separately.
• the method comprises administering the therapeutic agent (that is, the compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative, or pharmaceutical composition for use according to the invention) parenterally.
• the therapeutic agent that is, the compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative, or pharmaceutical composition for use according to the invention
• the therapeutic agent is administered orally.
• the therapeutic agent is administered intravenously. In certain preferred embodiments, the therapeutic agent is administered intraperitoneally. In certain preferred embodiments, the therapeutic agent is administered subcutaneously.
• the methods according to the invention comprises administering the therapeutic agent (that is, the compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative, or pharmaceutical composition for use according to the invention) at a dose in the range of from 10 to 150 mg/kg.
• the dose refers to the amount of the active ingredient administered to the subject per single administration.
• the method comprises administering the therapeutic agent at a dose in the range of from 25 to 125mg/kg. In certain preferred embodiments, the method comprises administering the therapeutic agent at a dose in the range of from 50 to 100mg/kg.
• the method comprises administering the therapeutic agent at a dose of 75mg/kg. ln certain preferred embodiments, the method comprises administering the therapeutic agent (that is, the compound, pharmaceutically acceptable salt, tautomer, stereoisomer or /V-oxide derivative, or pharmaceutical composition for use according to the invention) 1 , 2,
• the therapeutic agent is administered once or twice daily, most preferably twice daily.
• the therapeutic agent is administered at a daily dosage in the range of from 10 to 300 mg/kg. That is, the total amount of active agent administered to the subject in one day is in the range of from 10-300 mg/kg. In such embodiments, the therapeutic agent may be administered once or multiple times per day as described herein, provided the total daily dosage is in the indicated range.
• the therapeutic agent is administered at a daily dosage in the range of from 50 to 250 mg/kg. In certain preferred embodiments, the therapeutic agent is administered at a daily dosage in the range of from 75 to 250 mg/kg. In certain preferred embodiments, the therapeutic agent is administered at a daily dosage in the range of from 100 to 200 mg/kg. In certain preferred embodiments, the therapeutic agent is administered at a daily dosage of 150mg/kg.
• the therapeutic agent for example a compound as provided herein
• the subject or patient to be treated is a human.
• USP19 activity was determined in a fluorescence polarisation (FP) homogeneous assay using the isopeptide Ubiquitin-Lys-TAMRA substrate (either AUB-101 , Almac Sciences Scotland Limited, or U-558, Boston Biochem, both of which gave identical results).
• Full- length USP19 was purchased from Boston Biochem (E-576). Unless otherwise stated, all other reagents were purchased from Sigma. Enzymatic reactions were conducted in black flat bottom polystyrene 384-well plates (Nunc) and 30 pL total volume.
• USP19 (2.5 nM, 10 pL) was incubated in assay buffer (50 mM HEPES (pH 7.4), 150 mM NaCI, 5 mM DTT, 0.05% BSA (w/v), 0.05% CHAPS) in the presence or absence of inhibitor (10 pL).
• Inhibitors were stored as 10 mM DMSO stocks in an inert environment (low humidity, dark, low oxygen, room temperature) using the Storage Pod System and serial dilutions were prepared in buffer just prior to the assay (from 200 pM to 2 pM, 8-18 data point curve). Following incubation at RT for 30 min, the enzymatic reactions were initiated by dispensing the Ub substrate (500 nM, 10 pL).
• FP was measured every 15 min over a period of 90 min (within the linear range of the assay) using a Synergy 4 plate reader (BioTek) exciting at 530 nm and measuring the amount of parallel and perpendicular light at 575 nm. The FP signal was subsequently normalised to the no compound control. Data were plotted and fitted, and the concentrations resulting in 50% inhibition (IC50) were calculated using the non-linear regression curve fitting model using GraphPad (Prism). IC50 values for the inhibitors of the invention are compiled in Table 1 and represent the average of at least two duplicate experiments.
• a USP19 inhibitor compound (ADC-141 , corresponding to Example 212 provided herein) for 2 hrs, lysed (lysis buffer: 50mM Tris pH 7.4; 150mM NaCI; 5mM MgCI2; 0.5mM EDTA; 0.5% NP40; 10% Glycerol; 2mM DTT) and Ubiquitin- propargylamine (Ub-PA; UbiQ) or Ubiquitin-vinyl methyl ester (Ub-VME; Almac Sciences Scotland Limited) was then added. Samples were analysed by western blotting probing for USP19 (EC 50 determined by densitometry).
• a sham operation was carried out in the opposite leg as a control.
• Mice were randomised into Vehicle or Test groups, with all animals weighed to ensure a similar mean weight in each group.
• a USP19 inhibitory compound (ADC-141 , which is 1- (((S)-7-(( )-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10- yl)methyl)-4-phenyl-5-(piperazine-1-carbonyl)pyridin-2(1/-/)-one, corresponding to exemplary compound 212 provided herein) at 75 mg/kg or Vehicle was administered IP twice daily starting from the evening post-operation.
• mice were sacrificed 14 days later. Fat pads, liver, gastrocnemius and tibialis anterior muscles were harvested. Tissue mass were measured in both groups.
• the diet-induced obese (DIO) mouse is a well characterised model of obesity which exhibits increased adiposity, insulin resistance and glucose intolerance.
• mice Male C57BL6/J mice were continuously provided with high-fat diet (D12451 , 45% kcal as fat; Research Diets, New Jersey, USA) and filtered tap water ad libitum for the duration of the study. From day 0, mice were administered vehicle i.p. BID, USP19 inhibitor (ADC-141) i.p. BID at 5mg/kg or 25mg/kg, or positive control liraglutide 0.1mg/kg s.c. BID. Mice were allocated to treatment groups to balance the groups on the basis of body weight, food and water intake prior to the start of treatment.
• high-fat diet D12451 , 45% kcal as fat; Research Diets, New Jersey, USA
• ADC-141 USP19 inhibitor
• Mice were allocated to treatment groups to balance the groups on the basis of body weight, food and water intake prior to the start of treatment.
• Body weight was measured daily. On Day 13, body composition was assessed by DEXA. On Day 15, fasting glucose and insulin levels were measured before and during an oral glucose tolerance test (OGTT) to assess improvements in glucose control. The OGTT was performed following an overnight fast. Hence, on Day 14 food (but not water) was removed beginning at approximately 16:45, immediately after the PM dose. An OGTT was performed the following morning (approx. 16h post fast). Mice were dosed with vehicle or test compound (starting at 08.45) to a timed schedule 30 minutes prior to the administration of the glucose challenge (2.0 g/kg po). Blood samples were taken immediately prior to dosing (B1), immediately prior to glucose administration (B2) and 15, 30, 60 and 120 minutes after glucose administration.
• mice were humanely killed and carcass composition was assessed.
• the carcass was weighed and stored frozen and the chemical composition of each carcass (fat, protein, water and ash) was determined using classical techniques.
• Carcass water was determined by freeze-drying the carcasses to constant weight for 2 weeks.
• Carcass fat was determined on samples of the dry powdered carcasses using a modified Soxhlet extraction protocol (petroleum ether at 40-60°C) with a Tecator Soxtec 2050 system (Foss UK Ltd, Wheldrake, UK) according to the manufacturer’s recommended protocol.
• Carcass protein was determined using a micro-Kjeldahl procedure on samples of the dry powdered carcasses using a Tecator 2012 digestion block and 2200 distilling unit (Foss UK Ltd). Residual carcass ash was determined by firing samples of the dry powdered carcasses at high temperatures using a muffle ashing furnace (Carbolite OAF 11/1). Repeat
• mice receiving a USP19 inhibitor had a significantly lower loss of muscle mass in the tibialis anterior muscle compared to mice receiving vehicle only.
• the sparing of muscle atrophy was evident both in terms of percentage mass (Figure 1 B) and absolute muscle mass (Figure 1C).
• Figure 3A shows the mass of the epididymal fat pad in mice following 2 weeks of receiving a USP19 inhibitor or vehicle alone. As shown in Figure 3, mice which received the USP19 inhibitor had significantly smaller fat pads compared to vehicle treated mice.
• Figure 3B shows an increase in liver mass in mice treated with a USP19 inhibitor. This is thought to be as a result of drug accumulation in the liver.
• Figure 3C shows that mice receiving USP19 inhibitor exhibited a reduction in overall body weight gain when on a high-fat diet. Average weekly body weight gain was significantly decreased by USP19 inhibitor (25 mg/kg ip bid) in week 1 and 2 (p ⁇ 0.001 and p ⁇ 0.01 respectively). In contrast, Liraglutide significantly decreased body weight gain in week 1 (p ⁇ 0.001) but not week 2 (p>0.05).
• Figures 3D and 3E show USP19 inhibitor treated mice exhibited a reduction in fat mass by 24% compared to the vehicle treated controls (p ⁇ 0.001), but that lean body mass does not change significantly (-3%; p>0.05.
• Liraglutide 0.1 mg/kg sc bid
• Figure 4 shows body composition data determined based on carcass material.
• USP19 inhibitor 25 mg/kg ip bid
• Liraglutide 0.1 mg/kg sc bid
• Reductions in carcass weight observed following two weeks administration of USP19 inhibitor 25 mg/kg ip bid
• Liraglutide 0.1 mg/kg sc bid
• Reductions in carcass weight observed following two weeks administration of USP19 inhibitor 25 mg/kg ip bid
• Liraglutide 0.1 mg/kg sc bid
• closely reflected differences in body weights on the final day of the study c. 13%).
• USP19 inhibitor (5 and 25 mg/kg ip bid) had no significant effect on carcass water content, whereas Liraglutide caused a significant reduction in carcass water content (g; -8.6%; p ⁇ 0.001).
• USP19 inhibitor 25 g/kg ip bid
• ADC-141 5 g/kg ip bid
• Liraglutide 0.1 g/kg sc bid
• Carcass protein content was significantly decreased by USP19 inhibitor ADC-141 (25 mg/kg ip bid; -7.2%; p ⁇ 0.05) and Liraglutide (0.1 mg/kg sc bid; -7.9%; p ⁇ 0.05). However, when expressed as a percentage of total carcass mass, percent protein was significantly increased (6.0% and 5.7% respectively; p ⁇ 0.05; Figure 4). The lowest dose of ADC-141 (5 mg/kg ip bid) produced no significant changes in carcass protein when compared to vehicle-treated animals.
• Carcass ash content (g) was significantly reduced by USP19 inhibitor ADC-141 (25 mg/kg ip bid; -9.6%; p ⁇ 0.05) and Liraglutide (0.1 mg/kg sc bid; -11.6%; p ⁇ 0.01). However, when expressed as a percentage of total carcass mass, there was no significant difference in carcass ash for any of the treatment groups in comparison to control values (Figure 4).
• DIO mice treated with USP19 inhibitor also exhibited a reduction in cumulative and average food intake compared to vehicle control mice (p ⁇ 0.001).
• UP19 inhibition is able to reduce fat accumulation while preserving or increasing relative body protein and ash content.
• Figure 6 shows the results of an oral glucose tolerance test (OGTT) in mice with diet- induced obesity.
• USP19 inhibitor ADC-141 25 mg/kg ip bid significantly reduced plasma glucose at all time points pre- and post-glucose (Figure 6A) and glucose AUC ( Figure 6B) and AUCB2 (0-120 minutes only), compared to the vehicle group.
• USP19 inhibitor ADC-141 25 mg/kg ip bid also reduced plasma insulin at 30, 60 and 120 minutes post-glucose, and insulin AUC (0-60 and 0-120 minutes; Figure 6C).
• USP19 inhibition was effective at decreasing fasting plasma glucose whilst maintaining plasma insulin levels similar to that of the controls, indicating improved insulin sensitivity. Consistent with these observations in the fasted state, when challenged with a glucose load USP19 inhibition led to improved glucose disposal and stimulated a diminished increase in plasma insulin (at 30, 60 and 120 minutes) compared to that of the controls. Therefore, treatment with a USP19 inhibitor was effective at improving insulin sensitivity and glucose tolerance in the DIO mouse model of insulin resistance.
• the data shown in Figure 6 is the first demonstration that pharmacological inhibition of USP19 can reduce insulin resistance in a wild-type background. Gene knockout studies have also described an association between USP19 and insulin sensitivity (Coyne et al, supra). Coyne et al. describe an improvement in insulin sensitivity in USP19 knockout mice but, as noted above, it could not be assumed that the effects would translate to
• USP19 inhibitors for example those compounds provided herein and disclosed in WO2018/020242, can effectively treat muscular atrophy, obesity, insulin resistance and/or cancer.
• WO2018/020242 is expressly incorporated herein by reference in particular.
• Example 11 (ffl-4-(Dimethylamine)-1-((4-hvdrexy-1-(3-phenylbutanevnpiperidin-4- yl)methyl)-5-phenylpyridin-2(1 /-/)-ene
• Example 12 (ffl-1-((4-Hvdrexy-1-(3-phenylbutanev0piperidin-4-v0methv0-5-phenyl-4- (prop-1-en-2-vDpyridine-2(1/-/)-one
• Example 16 (R-3-((4-Hvdrexy-1-(3-phenylbutanev0piperidin-4-v0methv0-6-(1-methyl-1 H- indazel-7-v0pyrimidin-4(3/-/1-ene)
• Example 17 (ffl-3-((4-Hvdrexy-1-(3-phenylbutanev0piperidin-4-v0methv0-6-(2- methoxyphenvDpyrimidin-4(3/-/)-one
• Example 21 (f?)-6-(3-(1 ,3-Diexelan-2-yl)phenyl)-3-((4-hydrexy-1-(3- phenylbutaneyl)piperidin-4-yl)methyl)pyrimidin-4(3/-/)-ene
• Example 22 (f?)-3-((4-Hvdroxy-1-(3-phenylbutanoyl)piperidin-4-yl)methyl)-6-(thiophen-3- yl)pyrimidin-4(3/-/)-one
• Example 23 4-(2-Fluorophenyl)-1-((4-hvdroxy-1-(1-methylcyclopentane-1- carbonyl)piperidin-4-yl)methyl)-/ ⁇ /-isopropyl-/ ⁇ /-methyl-6-oxo-1 ,6-dihvdropyridine-3- carboxamide
• Example 26 (f?)-6-(Furan-2-yl)-3-((4-hvdroxy-1-(3-phenylbutanoyl)piperidin-4- yl1methv0pyrimidin-4(3/-/)-one
• Example 27 (ffl-1-((4-Hvdrexy-1-(3-phenylbutanev0piperidin-4-v0methv0-4-phenylpyridin- 2(M-l)-one
• Example 31 3-(((1 5S)-3-((ffl-3-Cvclehexyl-2-methylprepanevD-8-hvdrexy-3- azabicvcler3.2.11ectan-8-yl)methyl)-6-(2-fluerephenyl)pyrimidin-4(3/-/)-ene
• Example 32 (f?)-6-(2-Fluorophenyl)-3-((4-hvdroxy-1-(3-phenylbutanoyl)piperidin-4- yl)methvDpyrimidin-4(3/-/)-one
• Example 36 (f?)-1-((1-(3-Cvclohexyl-2-methylpropanoyl)-4-hvdroxypiperidin-4-yl)methyl)-4- phenyl-5-(piperidine-1-carbonyl)pyridin-2(1 /-/)-one
• Example 37 (f?)-2-((4-Hvdroxy-1-(3-phenylbutanoyl)piperidin-4-yl)methyl)-5- phenylpyridazin-3(2/-/)-one
• Example 38 (ffl-4-(2-CvanophenvD-1-((4-hvdroxy-1-(3-phenylbutanovDpiperidin-4- yl)methvD-/ ⁇ /-isopropyl-/ ⁇ /-methyl-6-oxo-1.6-dihvdropyridine-3-carboxamide
• Example 41 rac-6-(2-Fluorophenyl)-3-((4-hydroxy-1-(c/s-2- phenylcvclopropanecarbonyl)piperidin-4-yl)methyl)pyrimidin-4(3/-/)-one
• Example 42 6-(2-Fluorophenyl)-3-((4-hvdroxy-1-(1-methylcvclohexanecarbonyl)piperidin-4- yl)methyl)pyrimidin-4(3/-/)-one
• Example 43 3-((S)-1-(1-((ffl-3-Cvclohexyl-2-methylpropanovD-4-hvdroxypiperidin-4- yllpropy0-6-phenylpyrimidin-4(3/-/1-one and 3-((R-1-(1-((R-3-cvclohexyl-2- methylpropanov0-4-hvdroxypiperidin-4-v0propy0-6-phenylpyrimidin-4(3/-/1-one
• Example 46 (R-5-((Dimethylamino1methvO-1-((4-hvdroxy-1-(3-phenylbutanovQpiperidin-4- yl)methvD-4-phenylpyridin-2(1 /-/1-one
• Example 47 3-((f?)-1-(4-Hvdroxy-1-((f?)-3-phenylbutanoyl)piperidin-4-yl)ethyl)-6- phenylpyrimidin-4(3/-/)-one and 3-((S)-1-(4-hvdroxy-1-((f?)-3-phenylbutanoyl)piperidin-4- yl)ethyl)-6-phenylpyrimidin-4(3/-/)-one
• Example 48 (ffl-6-(2-FluorophenvO-3-((4-hvdroxy-1-(4 4.4-trifluoro-3- phenylbutanoyl)piperidin-4-yl)methyl)pyrimidin-4(3/-/)-one
• Example 50 3-(((f?)-1-((f?)-3-Cvclohexyl-2-methylpropanoyl)-4-hydroxy-3,3- dimethylpiperidin-4-yl)methyl)-6-phenylpyrimidin-4(3/-/)-one and 3-(((S)-1-( -3-
• Example 51 3-(((ffl-6-((ffl-3-Cvclehexyl-2-methylprepanevO-9-hvdrexy-6- azaspirer3.51nenan-9-v0methv0-6-(2-fluerephenvQpyrimidin-4(3/-/1-ene and 3-(((S)-6-((R)-3- Cvclehexyl-2-methylprepanev0-9-hvdrexy-6-azaspirer3.51nenan-9-v0methv0-6-(2- fluerephenvQpyrimidin-4(3/-/1-ene
• Example 52 (ffl-5-(3-(Aminemethv0phenv0-1 -((1 -(3-cvclehexyl-2-methylprepanev0-4- hvdrexypiperidin-4-v0methv0-4-(2-fluerephenvQpyridin-2(1 /-/1-ene
• Example 53 3-(((S1-4-Hvdrexy-3.3-dimethyl-1 -((ffl-3-phenylbutanevQpiperidin-4-v0methv0- 6-phenylpyrimidin-4(3/-/)-ene and 3-(((ffl-4-hvdrexy-3,3-dimethyl-1 -((ffl-3- phenylbutanev0piperidin-4-v0methv0-6-phenylpyrimidin-4(3/-/1-ene
• Example 54 (f?)-6-(4-Fluerephenexy)-3-((4-hvdrexy-1-(3-phenylbutaneyl)piperidin-4- yl)methyl)pyrimidin-4(3/-/)-ene
• Example 56 6-(2-FluerephenvO-3-((4-hvdrexy-1-(1-methyl-4- methylenecyclehexanecarbenyl)piperidin-4-yl)rTiethyl)pyrirTiidin-4(3/-/)-ene
• Example 60 6-(2-Fluerephenyl)-3-(((1 5S)-8-hvdrexy-3-((f?)-3-phenylbutaneyl)-3- azabicvcler3.2.11ectan-8-yl)methyl)pyrimidin-4(3/-/)-ene
• Example 61 3-(((ffl-4-Hvdrexy-2.2-dimethyl-1-((ffl-3-phenylbutanev0piperidin-4-v0methv0- 6-phenylpyrimidin-4(3/-/)-one and 3-(((S1-4-Hvdrexy-2 2-dimethyl-1-((ffl-3- phenylbutanev0piperidin-4-v0methv0-6-phenylpyrimidin-4(3/-/1-ene
• Example 62 (f?)-1-((4-Hvdrexy-1-(3-phenylbutaneyl)piperidin-4-yl)methyl)-5-(4- hvdrexypiperidine-1-carbenyl)-4-phenylpyridin-2(1 /-/)-ene
• Example 64 (ffl-1-((4-Hvdrexy-1-(3-phenylbutanevDpiperidin-4-vDmethvD-4-phenyl-5-(1.4- diexa-8-azaspirer4.51decane-8-carbenyl)pyridin-2(1 /-/)-ene
• Example 66 6-(2-FluorophenvD-3-((4-hvdroxy-3.3-dimethyl-1-(c/s-2-phenylcvclopropane-1- carbonv0piperidin-4-v0methv0pyrimidin-4(3/-/)-one
• Example 68 -6-(2-Fluorophenyl)-3-((4-hvdroxy-3,3-dimethyl-1-(3-
• Example 70 6-(2-FluerephenvO-3-((4-hvdrexy-3 3-dimethyl-1-(3-methyl-3-
• Example 72 1-((4-Hvdrexy-1-(1-(thiephen-2-v0cvcleprepane-1-carbenvQpiperidin-4- vl)methvD-/ ⁇ /-ispprppvl-/ ⁇ /-methvl-6-pxp-4-phenvl-1 ,6-dihvdrppvridine-3-carbPxamide
• Example 73 1-(((R-1-((R-3-Cvclehexyl-2-methylprepanevO-4-hvdrexy-3 3- dimethylpiperidin-4-v0methv0-/ ⁇ /-iseprepyl-/ ⁇ /-methyl-6-exe-4-phenyl-1.6-dihvdrepyridine-3- carbexamide and 1-(((S1-1-((R-3-Cvclehexyl-2-methylprepanevO-4-hvdrexy-3 3- dimethylpiperidin-4-yl)methyl)-/ ⁇ /-iseprepyl-/ ⁇ /-methyl-6-exe-4-phenyl-1 ,6-dihvdrepyridine-3- carbexamide
• Example 79 ( S)-1-((1-(3-CvclebutylprepanevD-4-hvdrexy-3.3-dimethylpiperidin-4- yl)methvD-/ ⁇ /-iseprepyl-/ ⁇ /-methyl-6-exe-4-phenyl-1.6-dihvdrepyridine-3-carbexamide
• Example 80 ( S1-1-((1-(2-Ethylhexanev0-4-hvdrexypiperidin-4-v0methv0-/ ⁇ /-iseprepyl-/ ⁇ /- methyl-6- 4-phenyl-1.6-dihvdrepyridine-3-carbexamide
• Example 84 1-((1-(2.2-Dimethylbutanev0-4-hvdrexypiperidin-4-v0methv0-/ ⁇ /-iseprepyl-/ ⁇ /- ethvl-6-pxp-4-phenvl-1 ,6-dihvdrppvridine-3-carbPxa ide
• Example 92 1-((1-(3-Cvclehexylprepanev0-4-hvdrexypiperidin-4-v0methv0-/ ⁇ /-iseprepyl-/ ⁇ /- methyl-6- 4-phenyl-1.6-dihvdrepyridine-3-carbexamide
• Example 96 (f?)-1-((4-Hvdroxy-1-(3-phenylbutanoyl)piperidin-4-yl)methyl)-/ ⁇ /-isopropyl-/ ⁇ /- methyl-6-oxo-4-(p-tolyl)-1 ,6-dihvdropyridine- 3-carboxamide
• Example 100 (ffl-5-(3-(Aminemethv0phenv0-1-((4-hvdrexy-1-(3-phenylbutanevQpiperidin- 4-v0methv0-4-phenylpyridin-2( 1 H)-one
• Example 101 (ffl-1-((4-Hvdrexy-1-(3-phenylbutanevQpiperidin-4-v0methv0-/ ⁇ /-iseprepyl-/ ⁇ /- methyl-6- 4-phenyl-1.6-dihvdrepyridine-3-carbexamide
• Example 102 (f?)-1-((4-Hvdrexy-1-(3-phenylbutaneyl)piperidin-4-yl)methyl)-/ ⁇ /-iseprepyl-/ ⁇ /- methyl-6- -1 ,6-dihydrepyridine-3-carbexamide
• Example 104 (ffl-A/-(CvcleprepylmethvO-1-((4-hvdrexy-1-(3-phenylbutanevQpiperidin-4- yl1methv0-6- 4-phenyl-1.6-dihvdrepyridine-3-carbexamide
• Example 106 (ffl-2-(1-((4-Hvdroxy-1-(3-phenylbutanovDpiperidin-4-vDmethvD-6-oxo-4- phenyl-1 ,6-dihvdropyridin-3-yl)benzonitrile
• Example 108 3-( 1 -(1 -((ffl-3-Cvclohexyl-2-methylpropanov0-4-hvdroxypiperidin-4-v0ethv0- 6-phenylpyrimidin-4(3/-/)-one
• Example 109 (ffl-1-((4-Hvdrexy-1-(3-phenylbutanev0piperidin-4-v0methv0-5-(1-methyl-1 /-/- pyrazel-4-v0-4-phenylpyridin-2(1 H)-one
• Example 110 (ffl-3-((1-(2-(Cvclehexylmethv0pent-4-enev0-4-hvdrexypiperidin-4- yl1methvO-6-(2-fluerephenvQpyrimidin-4(3/-/1-ene
• Example 11 1 (f?)-1-((4-Hvdrexy-1-(3-phenylbutaneyl)piperidin-4-yl)methyl)-5-methyl-4- phenylpyridin-2( 1 H)-o ne
• Example 112 (ffl-6-(1.5-Dimethyl-1 H-pyrazel-4-vn-3-((4-hvdrexy-1-(3- phenylbutanov0piperidin-4-v0methvQpyrimidin-4(3/-/1-one
• Example 113 3-(( -3-(3-Cvclehexylprepaneyl)-8-hvdrexy-3-azabicycler3.2.11ectan-
• Example 115 (f?)-1-((4-Hvdrexy-1-(3-phenylbutaneyl)piperidin-4-yl)methyl)-/ ⁇ /-(2- hvdrexyethyl)-6- 4-phenyl-1 ,6-dihydrepyridine-3-carbexamide
• Example 116 1-((4-Hvdrexy-1-((ffl-3-phenylbutanev0piperidin-4-v0methv0-5-((S1-2- methylpyrrelidine-1-carbenv0-4-phenylpyridin-2(1/-/1-ene
• Example 120 1-(((S)-1-((f?)-3-Cvclchexyl-2-methylprcpancyl)-4-hydrcxy-3,3- dimethylpiperidin-4-yl)methyl)-/ ⁇ /-iscprcpyl-/ ⁇ /-methyl-6-cxc-4-phenyl-1 ,6-dihvdrcpyridine-3- carbexamide
• Example 121 1-(((S1-1-((ffl-3-Cvclchexyl-2-methylprcpancvO-4-hvdrcxy-3,3- dimethylpiperidin-4-v0methv dimethyl-6-cxc-4-phenyl-1.6-dihvdrcpyridine-3-
• Example 122 1-(((ffl-1-((ffl-3-Cvclchexyl-2-methylprcpancvD-4-hvdrcxy-3,3- dimethylpiperidin-4-v0methv0-/ ⁇ /./ ⁇ /-dimethyl-6-cxc-4-phenyl-1.6-dihvdrcpyridine-3- carbcxamide
• Example 123 1-(((S1-1-((ffl-3-Cvclehexyl-2-methylprepanevO-4-hvdrexy-3,3- dimethylpiperidin-4-v0methv0-4-phenyl-5-(pyrrelidine-1-carbenvQpyridin-2(1 /-/1-ene
• Example 124 1-(((S)-1-((f?)-3-Cvclehexyl-2-methylprepaneyl)-4-hydrexy-3,3- dimethylpiperidin-4-yl)methyl)-4-phenyl-5-(piperazine-1- pyridin-2(1 /-/)-ene
• Example 125 1-(((ffl-1-((ffl-3-Cvclehexyl-2-methylprepanevO-4-hvdrexy-3,3- dimethylpiperidin-4-v0methv0-4-phenyl-5-(piperazine-1-carbenvQpyridin-2(1 /-/1-ene
• Example 126 3-((1-(2-(CvclehexylexylprepanevO-4-hvdrexy-3,3-dimethylpiperidin-4- yl1methvO-6-(2-fluerephenvQpyrimidin-4(3/-/1-ene
• Example 127 1-((7-((f?)-3-Cvclehexyl-2-methylprepaneyl)-10-hydrexy-7- azaspirer4.51decan-10-yl)methyl)-/ ⁇ /,A/-dimethyl-6-exe-1 ,6-dihvdrepyridine-3-carbexamide
• Example 129 1-((1-((ffl-3-Cvclopropyl-2-methylpropanovD-4-hvdroxy-3,3- dimethylpiperidin-4-v0methv0-/ ⁇ /./ ⁇ /-dimethyl-6-oxo-4-phenyl-1.6-dihvdropyridine-3- carboxamide
• Example 131 3-((1-((f?)-3-Cvclohexyl-2-methylpropanoyl)-4-hvdroxy-3,3-dimethylpiperidin- 4-yl)methyl)-6-(1-methyl-1 /-/-pyrazol-5-yl)pyrimidin-4(3/-/)-one
• Example 132 3-((1-((f?)-3-Cvclohexyl-2-methylpropanoyl)-4-hvdroxy-3,3-dimethylpiperidin- 4-yl)methyl)-6-(1 /-/-pyrazol-4-yl)pyrimidin-4(3/-/)-one
• Example 133 3-((1-((ffl-3-Cvclehexyl-2-methylprepanevO-4-hvdrexy-3,3-dimethylpiperidin- 4-v0methv0-6-( 1 /-/-pyrazel-5-v0pyrimidin-4(3/-/1-ene
• Example 134 3-((7-((f?)-3-Cvclehexyl-2-methylprepaneyl)-10-hydrexy-7- azaspirer4.51decan-10-yl)methyl)pyrimidin-4(3/-/)-ene
• Example 135 3-((1-((f?)-3-Cvclehexyl-2-methylprepaneyl)-4-hvdrexy-3,3-dimethylpiperidin- 4-yl)methyl)-6-(thiephen-3-yl)pyrimidin-4(3/-/)-ene
• Example 136 1-((1-((f?)-3-Cvclehexyl-2-methylprepaneyl)-4-hvdrexy-3,3-dimethylpiperidin- 4-yl)methyl)-5-(exazel-2-yl)-4-phenylpyridin-2(1 /-/)-ene
• Example 137 3-((1-((ffl-3-Cvclehexyl-2-methylprepanevO-4-hvdrexy-3,3-dimethylpiperidin- 4-v0methv0-6-(2-(hvdrexymethv0phenvQpyrimidin-4(3/-/)-ene
• Example 140 6-(4-(AminemethvDphenvD-3-((1-((ffl-3-cvclehexyl-2-methylprepanevD-4- hvdrexy-3.3-dimethylpiperidin-4-v0methv0pyrimidin-4(3/-/)-ene
• Example 141 6-(2-(Aminemethyl)phenyl)-3-((1-((f?)-3-cvclehexyl-2-methylprepaneyl)-4- hvdrexy-3,3-dimethylpiperidin-4-yl)methyl)pyrimidin-4(3/-/)-ene
• Example 142 6-(2-FluerephenvO-3-((4-hvdrexy-3,3-dimethyl-1-(2.4.4- trimethylpentanev0piperidin-4-v0methv0pyrimidin-4(3/-/1-ene
• Example 143 6-(2-FluorophenvO-3-((4-hvdroxy-3,3-dimethyl-1-(4.4.4-trifluoro-2- methylbutanov0piperidin-4-v0methvQpyrimidin-4(3/-/1-one
• Example 144 4-Chloro-1-((7-( -3-cvclohexyl-2-methylpropanoyl)-10-hydroxy-7-
• Example 145 1-((7-((f?)-3-Cvclohexyl-2-methylpropanoyl)-10-hydroxy-7- azaspiror4.51decan-10-yl)methyl)-4-(dirnethylamino)-/ ⁇ /,/ ⁇ /-dirnethyl-6-oxo-1 ,6- dihydropyridine- 3-carboxamide
• Example 146 1-((1-((S)-3-(Benzyloxy)-2-(cvclohexylmethyl)propanoyl)-4-hydroxy-3,3- dimethylpiperidin-4-yl)methyl)-A/,A/-dimethyl-6-oxo-4-phenyl-1 ,6-dihvdropyridine-3- carboxamide
• Example 148 1-((10-Hvdrexy-7-((ffl-2-methylbutanevO-7-azaspirer4.51decan-10-vOmethvO- A/,A/-dimethyl-6-oxo-4-phenyl-1.6-dihvdropyridine-3-carboxamide
• Example 149 1-((7-((ffl-3-Cvcleprepyl-2-methylprepanevO-1Q-hvdrexy-7- azaspirer4.51decan-10-vOmethvO-/ ⁇ /./ ⁇ /-dimethyl-6-exe-4-phenyl-1.6-dihvdrepyridine-3- carbexamide
• Example 150 6-(2-FluerephenvD-3-((4-hvdrexy-3.3-dimethyl-1-(2-methyl-3-(1 /-/-pyrazel-1- yl)prepaneyl)piperidin-4-yl)methyl)pyrimidin-4(3/-/)-ene
• Example 151 1-((7-((ffl-3-Cvclehexyl-2-methylprepanevD-10-hvdrexy-7- azaspirer4.5ldecan-10-vOmethvO-4-(2-(hvdrexymethvOphenvO-/ ⁇ /./ ⁇ /-dimethyl-6-exe-1.6- dihvdrepyridine-3-carbexamide
• Example 152 and Example 153 1-(((S1-1-((S1-3-Cvclehexyl-2-(hvdrexymethvQprepanevO- 4-hvdroxy-3.3-dimethylpiperidin-4-vDmethvD-/ ⁇ /./ ⁇ /-dirnethyl-6-oxo-4-phenyl-1.6- dihvdrppyridine-3-carbPxamide and 1-(((ffl-1-((S1-3-Cvclehexyl-2- (hvdrexymethv0prepanev0-4-hvdrexy-3.3-dimethylpiperidin-4-v0methv dimethyl-6-
• Example 154 1 '-((1-((f?)-3-Cvclehexyl-2-methylprepaneyl)-4-hvdrexy-3,3-dimethylpiperidin- 4-yl)methyl)-4'-(2-fluorophenylH2.3'-bipyridinl-6'( -one
• Example 155 1-((7-((f?)-3-Cvclehexyl-2-methylprepaneyl)-10-hydrexy-7- azaspirer4.51decan-10-yl)methyl)-A/,A/-dimethyl-6- 4-(thiephen-3-yl)-1 ,6-dihvdrepyridine-
• Example 156 1-((7-((f?)-3-Cvclehexyl-2-methylprepaneyl)-10-hydrexy-7- azaspirer4.51decan-10-yl)methyl)-4-(3-(hvdrexymethyl)phenyl)-/ ⁇ /,A/-dimethyl-6-exe-1 ,6- dihydrepyridine-3-carbexamide
• Example 157 1-((7-(3-Cvclohexyl-2-hvdroxypropanov0-10-hvdroxy-7-azaspiror4.51decan-
• Example 158 1-((10-Hvdroxy-7-(2-methyl-3-(piperidin-1-vDpropanovD-7- azaspiror4.51decan-10-vnmethvn- dimethyl-6-oxo-4-phenyl-1.6-dihvdropyridine-3-
• Example 159 6-(3-(AminomethvDphenvD-3-((1-((ffl-3-cvclohexyl-2-methylpropanovD-4- hydroxy-3,3-dimethylpiperidin-4-yl)methyl)pyrimidin-4(3/-/)-one
• Example 160 1-(((S)-1-((S)-3-Cvclohexyl-2-(methoxymethvQpropanovO-4-hvdroxy-3.3- dimethylpiperidin-4-v0methv dimethyl-6-oxo-4-phenyl-1.6-dihvdropyridine-3-
• Example 161 4-(2-(Aminemethv0phenv0-1-((7-((ffl-3-cvclehexyl-2-methylprepanev0-1 Q- hvdrexy-7-azaspirer4.51decan-1 Q-vOmethvO-/ ⁇ /./ ⁇ /-dimethyl-6-exe-1.6-dihvdrepyridine-3- carbexamide
• Example 162 1-((7-((ffl-3-Cvclehexyl-2-methylprepanevQ-10-hvdrexy-7- azaspirer4.51decan-10-yl)methyl)-4-(4-(hvdrexymethyl)phenyl)-/ ⁇ /,A/-dimethyl-6-exe-1 ,6- dihydrepyridine-3-carbexamide
• Example 164 and Example 165 1-(((S1-1-((S1-2-(CvclehexylmethvO-4-hvdrexybutanevO-4- hvdrexy-3.3-dimethylpiperidin-4-v0methv0-/ ⁇ /./ ⁇ /-dimethyl-6-exe-4-phenyl-1.6- dihydrepyridine-3-carbexamide and 1-(((f?)-1-((S)-2-(Cvclehexylmethyl)-4- hvdrexybutaneyl)-4-hvdrexy-3,3-dimethylpiperidin-4-yl)methyl)-/ ⁇ /,A/-dimethyl-6-exe-4- phenyl-1 ,6-dihydrepyridine-3-carbexamide
• Example 166 and Example 167 1-(((S1-1-((S1-3-Cvclebutyl-2-(hvdrexymethvQprepanevO-4- hvdroxy-3.3-dimethylpiperidin-4-vDmethvD-/ ⁇ /./ ⁇ /-dimethyl-6-oxo-4-phenyl-1.6- dihvdrepyridine-3-carbexamide and 1-(((ffl-1-((S1-3-Cvclebutyl-2- (hvdrexymethv0prepanev0-4-hvdrexy-3.3-dimethylpiperidin-4-v0methv dimethyl-6-
• Example 168 1-((1-((f?)-3-Cvclehexyl-2-methylprepaneyl)-4-hvdrexy-3,3-dimethylpiperidin- 4-yl)methyl)-5-(merpheline-4-carbenyl)-4-phenylpyridin-2(1/-/)-ene
• Example 169 5-(4-Acetylpiperazine-1-carbenyl)-1-((1-((f?)-3-cvclehexyl-2- methylprepaneyl)-4-hvdrexy-3,3-dimethylpiperidin-4-yl)methyl)-4-phenylpyridin-2(1 /-/)-ene

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