Classifications

• • C—CHEMISTRY; METALLURGY
  • C07—ORGANIC CHEMISTRY
  • C07D—HETEROCYCLIC COMPOUNDS
  • C07D281/00—Heterocyclic compounds containing rings of more than six members having one nitrogen atom and one sulfur atom as the only ring hetero atoms
  • C07D281/02—Seven-membered rings
  • C07D281/04—Seven-membered rings having the hetero atoms in positions 1 and 4
  • C07D281/08—Seven-membered rings having the hetero atoms in positions 1 and 4 condensed with carbocyclic rings or ring systems
  • C07D281/10—Seven-membered rings having the hetero atoms in positions 1 and 4 condensed with carbocyclic rings or ring systems condensed with one six-membered ring
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
  • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
• • 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

Definitions

• bile acids secreted across the canalicular membrane into bile are derived from the recirculating pool with less than 10% coming from new de novo hepatic synthesis.
• the small fraction of bile acids that is not reabsorbed in the ileum reaches the colon.
• the primary bile acids are transformed into secondary bile acids under the action of intestinal bacteria, mainly by single or dual dehydroxylation reactions of the steroid nucleus.
• the bile acids that escape intestinal absorption are thereafter excreted into the faeces.
• C 1-4 haloalkyl refers to a straight or branched C 1-4 alkyl group, as defined herein, wherein one or more hydrogen atoms have been replaced with halogen. Examples of C 1-4 haloalkyl include chloromethyl, fluoroethyl and trifluoromethyl.
• C 1-4 alkoxy and “C 1-4 alkylthio” refer to a straight or branched C 1-4 alkyl group attached to the remainder of the molecule through an oxygen or sulphur atom, respectively.
• C 3-6 cycloalkyl refers to a monocyclic saturated hydrocarbon ring having from 3 to 6 carbon atoms.
• N-(C 1-4 alkyl)amino and “N,N- di(C 1-4 alkyl)amino” refer to an amino group wherein one or both hydrogen atom(s), respectively, are replaced with a straight or branched C 1-4 alkyl group.
• Examples of N-(C 1-4 alkyl)amino include methylamino, ethylamino and tert-butylamino, and examples of N,N-di-(C 1-4 alkyl)amino include dimethylamino and diethylamino.
• PFIC type 1
• ⁇ PFIC type 2
• Boler syndrome is caused by impaired bile salt secretion due to mutations in the ABCB11 gene, which codes for a protein, known as the bile salt export pump, that moves bile acids out of the liver.
• Subjects with PFIC, type 2 often develop liver failure within the first few years of life and are at increased risk of developing a type of liver cancer known as hepatocellular carcinoma.
• an nucleotide position in a reference gene sequence that corresponds to a specific nucleotide position in SEQ ID NO: 2 or 4 can be determined by aligning the reference gene sequence with SEQ ID NO: 2 or 4 (e.g., using a software program, such as ClustalW2). Changes to these residues (referred to herein as “mutations”) may include single or multiple nucleotide substitutions, insertions within or flanking the sequences, and deletions within or flanking the sequences. See also Kooistra, et al., “KLIFS: A structural kinase-ligand interaction database,” Nucleic Acids Res.2016, vol.44, no. D1, pp. D365- D371, which is incorporated by reference in its entirety herein.
• Canonical protein sequence of ATP8B1 (SEQ ID NO: 1) – Uniprot ID O43520 Canonical DNA Sequence for ATP8B1 (SEQ ID NO: 2)
• the mutation in ABCB11 is selected from A167T, G238V, V284L, E297G, R470Q, R470X, D482G, R487H, A570T, N591S, A865V, G982R, R1153C, and R1268Q.
• PFIC e.g., PFIC-1 and PFIC-2
• methods of treating PFIC PFIC-1 and PFIC-2 in a subject that includes performing an assay on a sample obtained from the subject to determine whether the subject has a mutation associated with PFIC (e.g., a ATP8B1, ABCB11, ABCB4, TJP2, NR1H4 or Myo5b mutation), and administering (e.g., specifically or selectively administering) a therapeutically effective amount of a compound of formula (I), or a pharmaceutically acceptable salt thereof, to the subject determined to have a mutation associated with PFIC.
• the mutation is a ATP8B1 or ABCB11 mutation.
• PFIC e.g., PFIC-1 and PFIC-2
• a mutation associated with PFIC e.g., a ATP8B1, ABCB11, ABCB4, TJP2, NR1H4 or Myo5b mutation
• methods for treating PFIC can include administering a therapeutically effective amount of a compound of formula (I), or a pharmaceutically acceptable salt thereof, to a subject having a mutation associated with PFIC (e.g., a ATP8B1, ABCB11, ABCB4, TJP2, NR1H4 or Myo5b mutation).
• a mutation associated with PFIC e.g., a ATP8B1, ABCB11, ABCB4, TJP2, NR1H4 or Myo5b mutation.
• the mutation is a ATP8B1 or ABCB11 mutation.
• the mutation in ATP8B1 is selected from L127P, G308V, T456M, D554N, F529del, I661T, E665X, R930X, R952X, R1014X, and G1040R.
• the mutation in ABCB11 is selected from A167T, G238V, V284L, E297G, R470Q, R470X, D482G, R487H, A570T, N591S, A865V, G982R, R1153C, and R1268Q.
• the level of serum bile acids can decrease by, for example, 10% to 40%, 20% to 50%, 30% to 60%, 40% to 70%, 50% to 80%, or by more than 90% of the level of serum bile acids prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the treatment of PFIC includes treatment of pruritus. Since LBAT is expressed on hepatocytes, LBAT and dual ASBT/LBAT inhibitor substances need to have at least some bioavailability and free fraction in blood. Because LBAT inhibitor compounds only need to survive from the intestine to the liver, it is expected that a relatively low systemic exposure of such compounds will be sufficient, thereby minimizing the potential risk for any side effects in the rest of the body.
• LBAT and ASBT will have at least additive effects in decreasing the intrahepatic bile acid concentration. It is also expected that a dual ASBT/LBAT inhibitor may be able to reduce bile acid levels without inducing diarrhoea, as is sometimes observed with ASBT inhibitors.
• Compounds having a high LBAT inhibiting potency and sufficient bioavailability are expected to be particularly suitable for the treatment of hepatitis.
• Compounds having a dual ASBT/LBAT inhibiting potency and sufficient bioavailability are expected to be particularly suitable for the treatment of non-alcoholic steatohepatitis (NASH).
• NASH non-alcoholic steatohepatitis
• NASH is a common and serious chronic liver disease that resembles alcoholic liver disease, but that occurs in people who drink little or no alcohol.
• fat accumulation in the liver known as nonalcoholic fatty liver disease (NAFLD) or steatosis
• NAFLD nonalcoholic fatty liver disease
• other factors such as high LDL cholesterol and insulin resistance induce chronic inflammation in the liver and may lead to progressive scarring of tissue, known as fibrosis, and cirrhosis, followed eventually by liver failure and death.
• Patients with NASH have been found to have significantly higher total serum bile acid concentrations than healthy subjects under fasting conditions (2.2- to 2.4-fold increase in NASH) and at all post-prandial time points (1.7- to 2.2-fold increase in NASH).
• NAFLD is characterized by hepatic steatosis with no secondary causes of hepatic steatosis including excessive alcohol consumption, other known liver diseases, or long-term use of a steatogenic medication (Chalasani et al., Hepatology 2018, vol.67(1), p.328-357). NAFLD can be categorized into non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). According to Chalasani et al., NAFL is defined as the presence of ⁇ 5% hepatic steatosis without evidence of hepatocellular injury in the form of hepatocyte ballooning.
• NASH is defined as the presence of ⁇ 5% hepatic steatosis and inflammation with hepatocyte injury (e.g., ballooning), with or without any liver fibrosis. NASH is also commonly associated with hepatic inflammation and liver fibrosis, which can progress to cirrhosis, end-stage liver disease, and hepatocellular carcinoma. While liver fibrosis is not always present in NASH, the severity of the fibrosis, when present, can be linked to long-term outcomes. There are many approaches used to assess and evaluate whether a subject has NAFLD and if so, the severity of the disease, including differentiating whether the NAFLD is NAFL or NASH. In some embodiments, the severity of NAFLD can be assessed using the NAS.
• treatment of NAFLD can be assessed using the NAS.
• the NAS can be determined as described in Kleiner et al., Hepatology.2005, 41(6):1313-1321, which is hereby incorporated by reference in its entirety. See, for example, Table 6 for a simplified NAS scheme adapted from Kleiner.
• the NAS is determined non-invasively, for example, as described in U.S. Application Publication No.2018/0140219, which is incorporated by reference herein in its entirety.
• the NAS is determined for a sample from the subject prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the NAS is determined during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• a lower NAS score during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof indicates treatment of NAFLD (e.g., NASH).
• NAFLD e.g., NASH
• a decrease in the NAS by 1, by 2, by 3, by 4, by 5, by 6, or by 7 indicates treatment of NAFLD (e.g., NASH).
• the NAS following administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof is 7 or less.
• the NAS during the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof is 5 or less, 4 or less, 3 or less, or 2 or less. In some embodiments, the NAS during the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, is 7 or less. In some embodiments, the NAS during the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, is 5 or less, 4 or less, 3 or less, or 2 or less. In some embodiments, the NAS after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, is 7 or less.
• the NAS after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof is 5 or less, 4 or less, 3 or less, or 2 or less.
• Additional approaches of assessing and evaluating NASH in a subject include determining one or more of hepatic steatosis (e.g., accumulation of fat in the liver); hepatic inflammation; biomarkers indicative of one or more of liver damage, hepatic inflammation, liver fibrosis, and/or liver cirrhosis (e.g., serum markers and panels).
• Further examples of physiological indicators of NASH can include liver morphology, liver stiffness, and the size or weight of the subject’s liver.
• NASH in the subject is evidenced by an accumulation of hepatic fat and detection of a biomarker indicative of liver damage.
• elevated serum ferritin and low titers of serum autoantibodies can be common features of NASH.
• methods to assess NASH include magnetic resonance imaging, either by spectroscopy or by proton density fat fraction (MRI-PDFF) to quantify steatosis, transient elastography (FIBROSCAN®), hepatic venous pressure gradient (HPVG), hepatic stiffness measurement with MRE for diagnosing significant liver fibrosis and/or cirrhosis, and assessing histological features of liver biopsy.
• MRI-PDFF proton density fat fraction
• HPVG hepatic venous pressure gradient
• MRE hepatic stiffness measurement with MRE for diagnosing significant liver fibrosis and/or cirrhosis
• magnetic resonance imaging is used to detect one or more of steatohepatitis (NASH-MRI), liver fibrosis (Fibro-MRI), and steatosis.
• NASH-MRI steatohepatitis
• Fibro-MRI liver fibrosis
• steatosis steatohepatitis
• treatment of NASH can include a decrease of one or more symptoms associated with NASH; reduction in the amount of hepatic steatosis; a decrease in the NAS; a decrease in hepatic inflammation; a decrease in the level of biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis; and a reduction in fibrosis and/or cirrhosis, a lack of further progression of fibrosis and/or cirrhosis, or a slowing of the progression of fibrosis and/or cirrhosis in the subject following administration of one or more doses of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• treatment of NASH comprises a decrease of one or more symptoms associated with NASH in the subject.
• exemplary symptoms can include one or more of an enlarged liver, fatigue, pain in the upper right abdomen, abdominal swelling, enlarged blood vessels just beneath the skin's surface, enlarged breasts in men, enlarged spleen, red palms, jaundice, and pruritus.
• the subject is asymptomatic.
• the total body weight of the subject does not increase.
• the total body weight of the subject decreases.
• the body mass index (BMI) of the subject does not increase.
• the body mass index (BMI) of the subject decreases.
• the waist and hip (WTH) ratio of the subject does not increase. In some embodiments, the waist and hip (WTH) ratio of the subject decreases.
• treatment of NASH can be assessed by measuring hepatic steatosis. In some embodiments, treatment of NASH comprises a reduction in hepatic steatosis following administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, as described herein.
• hepatic steatosis is determined by one or more methods selected from the group consisting of ultrasonography, computed tomography (CT), magnetic resonance imaging, magnetic resonance spectroscopy (MRS), magnetic resonance elastography (MRE), transient elastography (TE) (e.g., FIBROSCAN®), measurement of liver size or weight, or by liver biopsy (see, e.g., Di Lascio et al., Ultrasound Med Biol.2018, vol.44(8), p.1585-1596; Lv et al., J Clin Transl Hepatol.2018, vol.6(2), p.217-221; Reeder et al., J Magn Reson Imaging.2011, vol.34(4), spcone; and de Lédinghen V, et al., J Gastroenterol Hepatol.2016, vol.31(4), p.848-855, each of which are incorporated herein by reference in their entireties).
• CT computed to
• a subject diagnosed with NASH can have greater than about 5% hepatic steatosis, for example, greater than about 5% to about 25%, about 25% to about 45%, about 45% to about 65%, or greater than about 65% hepatic steatosis.
• a subject with greater than about 5% to about 33% hepatic steatosis has stage 1 hepatic steatosis
• a subject with about 33% to about 66% hepatic steatosis has stage 2 hepatic steatosis
• a subject with greater than about 66% hepatic steatosis has stage 3 hepatic steatosis.
• the amount of hepatic steatosis is determined prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof. In some embodiments, the amount of hepatic steatosis is determined during the period of time or after the period of time of administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof. In some embodiments, a reduction in the amount of hepatic steatosis during the period of time or after the period of time of administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof, indicates treatment of NASH.
• a reduction in the amount of hepatic steatosis by about 1% to about 50%, about 25% to about 75%, or about 50% to about 100% indicates treatment of NASH.
• a reduction in the amount of hepatic steatosis by about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, or about 95% indicates treatment of NASH.
• the presence of hepatic inflammation is determined by one or more methods selected from the group consisting of biomarkers indicative of hepatic inflammation and a liver biopsy sample(s) from the subject.
• the severity of hepatic inflammation is determined from a liver biopsy sample(s) from the subject.
• hepatic inflammation in a liver biopsy sample can be assessed as described in Kleiner et al., Hepatology 2005, vol.41(6), p. 1313-1321 and Brunt et al., Am J Gastroenterol 1999, vol.94, p.2467-2474, each of which are hereby incorporated by reference in their entireties.
• the severity of hepatic inflammation is determined prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the severity of hepatic inflammation is determined during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• a decrease in the severity of hepatic inflammation during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof indicates treatment of NASH.
• a decrease in the severity of hepatic inflammation by about 1% to about 50%, about 25% to about 75%, or about 50% to about 100% indicates treatment of NASH.
• a decrease in the severity of hepatic inflammation by about 5%, about 10%, about 15%, about 20%, about 25%, about 30%, about 35%, about 40%, about 45%, about 50%, about 55%, about 60%, about 65%, about 70%, about 75%, about 80%, about 85%, about 90%, or about 95% indicates treatment of NASH.
• treatment of NASH comprises treatment of fibrosis and/or cirrhosis, e.g., a decrease in the severity of fibrosis, a lack of further progression of fibrosis and/or cirrhosis, or a slowing of the progression of fibrosis and/or cirrhosis.
• the presence of fibrosis and/or cirrhosis is determined by one or more methods selected from the group consisting of transient elastography (e.g., FIBROSCAN®), non-invasive markers of hepatic fibrosis, and histological features of a liver biopsy.
• the severity (e.g., stage) of fibrosis is determined by one or more methods selected from the group consisting of transient elastography (e.g., FIBROSCAN®), a fibrosis-scoring system, biomarkers of hepatic fibrosis (e.g., non-invasive biomarkers), and hepatic venous pressure gradient (HVPG).
• Non-limiting examples of fibrosis scoring systems include the NAFLD fibrosis scoring system (see, e.g., Angulo et al., Hepatology 2007, vol. 45(4), p.846-54), the fibrosis scoring system in Brunt et al., Am. J. Gastroenterol.1999, vol.94, p. 2467-2474, the fibrosis scoring system in Kleiner et al., Hepatology 2005, vol.41(6), p.1313-1321, and the ISHAK fibrosis scoring system (see Ishak et al., J. Hepatol.1995, vol.22, p.696-699), the contents of each of which are incorporated by reference herein in their entireties.
• NAFLD fibrosis scoring system see, e.g., Angulo et al., Hepatology 2007, vol. 45(4), p.846-54
• the severity of fibrosis is determined prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof. In some embodiments, the severity of fibrosis is determined during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof. In some embodiments, a decrease in the severity of fibrosis during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof, indicates treatment of NASH.
• a decrease in the severity of fibrosis, a lack of further progression of fibrosis and/or cirrhosis, or a slowing of the progression of fibrosis and/or cirrhosis indicates treatment of NASH.
• the severity of fibrosis is determined using a scoring system such as any of the fibrosis scoring systems described herein, for example, the score can indicate the stage of fibrosis, e.g., stage 0 (no fibrosis), stage 1, stage 2, stage 3, and stage 4 (cirrhosis) (see, e.g., Kleiner et al).
• a decrease in the stage of the fibrosis is a decrease in the severity of the fibrosis.
• a decrease by 1, 2, 3, or 4 stages is a decrease in the severity of the fibrosis.
• a decrease in the stage e.g., from stage 4 to stage 3, from stage 4 to stage 2, from stage 4 to stage 1, from stage 4 to stage 0, from stage 3 to stage 2, from stage 3 to stage 1, from stage 3 to stage 0, from stage 2 to stage 1, from stage 2 to stage 0, or from stage 1 to stage 0 indicates treatment of NASH.
• the stage of fibrosis decreases from stage 4 to stage 3, from stage 4 to stage 2, from stage 4 to stage 1, from stage 4 to stage 0, from stage 3 to stage 2, from stage 3 to stage 1, from stage 3 to stage 0, from stage 2 to stage 1, from stage 2 to stage 0, or from stage 1 to stage 0 following administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the stage of fibrosis decreases from stage 4 to stage 3, from stage 4 to stage 2, from stage 4 to stage 1, from stage 4 to stage 0, from stage 3 to stage 2, from stage 3 to stage 1, from stage 3 to stage 0, from stage 2 to stage 1, from stage 2 to stage 0, or from stage 1 to stage 0 during the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the stage of fibrosis decreases from stage 4 to stage 3, from stage 4 to stage 2, from stage 4 to stage 1, from stage 4 to stage 0, from stage 3 to stage 2, from stage 3 to stage 1, from stage 3 to stage 0, from stage 2 to stage 1, from stage 2 to stage 0, or from stage 1 to stage 0 after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the presence of NASH is determined by one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis or scoring systems thereof.
• the severity of NASH is determined by one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis or scoring systems thereof.
• the level of the biomarker can be determined by, for example, measuring, quantifying, and monitoring the expression level of the gene or mRNA encoding the biomarker and/or the peptide or protein of the biomarker.
• biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis and/or scoring systems thereof include the aspartate aminotransferase (AST) to platelet ratio index (APRI); the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ratio (AAR); the FIB-4 score, which is based on the APRI, alanine aminotransferase (ALT) levels, and age of the subject (see, e.g., McPherson et al., Gut 2010, vol.59(9), p.1265-9, which is incorporated by reference herein in its entirety); hyaluronic acid; pro-inflammatory cytokines; a panel of biomarkers consisting of ⁇ 2- macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, gamma glutamyl transpeptidase (GGT) combined with a subject’s
• Biomarkers consisting of tissue inhibitor of metalloproteinase-1, hyaluronic acid, and ⁇ 2- macroglobulin (e.g., FIBROSPECT®); a panel of biomarkers consisting of tissue inhibitor of metalloproteinases 1 (TIMP-1), amino-terminal propeptide of type III procollagen (PIIINP) and hyaluronic acid (HA) (e.g., the Enhanced Liver Fibrosis (ELF) score, see, e.g., Lichtinghagen R, et al., J Hepatol.2013 Aug;59(2):236-42, which is incorporated by reference herein in its entirety).
• TGF tissue inhibitor of metalloproteinases 1
• PIIINP amino-terminal propeptide of type III procollagen
• HA hyaluronic acid
• ELF Enhanced Liver Fibrosis
• the presence of fibrosis is determined by one or more of the FIB-4 score, a panel of biomarkers consisting of ⁇ 2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, gamma glutamyl transpeptidase (GGT) combined with a subject’s age and gender to generate a measure of fibrosis and necroinflammatory activity in the liver (e.g., FIBROTEST®, FIBROSURE®), a panel of biomarkers consisting of bilirubin, gamma-glutamyltransferase, hyaluronic acid, ⁇ 2-macroglobulin combined with the subject’s age and sex (e.g., HEPASCORE®; see, e.g., Adams et al., Clin.
• HEPASCORE® see, e.g., Adams et al., Clin.
• a panel of biomarkers consisting of tissue inhibitor of metalloproteinase-1, hyaluronic acid, and ⁇ 2-macroglobulin e.g., FIBROSPECT®
• a panel of biomarkers consisting of tissue inhibitor of metalloproteinases 1 TRIP-1
• PIIINP amino-terminal propeptide of type III procollagen
• HA hyaluronic acid
• ELF Enhanced Liver Fibrosis
• the level of aspartate aminotransferase (AST) does not increase.
• the level of aspartate aminotransferase decreases. In some embodiments, the level of alanine aminotransferase (ALT) does not increase. In some embodiments, the level of alanine aminotransferase (ALT) decreases.
• the “level” of an enzyme refers to the concentration of the enzyme, e.g., within blood. For example, the level of AST or ALT can be expressed as Units/L.
• the severity of fibrosis is determined by one or more of the FIB-4 score, a panel of biomarkers consisting of ⁇ 2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, gamma glutamyl transpeptidase (GGT) combined with a subject’s age and gender to generate a measure of fibrosis and necroinflammatory activity in the liver (e.g., FIBROTEST®, FIBROSURE®), a panel of biomarkers consisting of bilirubin, gamma-glutamyltransferase, hyaluronic acid, ⁇ 2- macroglobulin combined with the subject’s age and sex (e.g., HEPASCORE®; see, e.g., Adams et al., Clin.
• HEPASCORE® see, e.g., Adams et al., Clin.
• Biomarkers consisting of tissue inhibitor of metalloproteinase-1, hyaluronic acid, and ⁇ 2-macroglobulin (e.g., FIBROSPECT®); and a panel of biomarkers consisting of tissue inhibitor of metalloproteinases 1 (TIMP-1), amino-terminal propeptide of type III procollagen (PIIINP) and hyaluronic acid (HA) (e.g., the Enhanced Liver Fibrosis (ELF) score).
• tissue inhibitor of metalloproteinase-1 hyaluronic acid
• HA hyaluronic acid
• hepatic inflammation is determined by the level of liver inflammation biomarkers, e.g., pro-inflammatory cytokines.
• biomarkers indicative of liver inflammation include interleukin-(IL) 6, interleukin-(IL) 1 ⁇ , tumor necrosis factor (TNF)- ⁇ , transforming growth factor (TGF)- ⁇ , monocyte chemotactic protein (MCP)-1, C-reactive protein (CRP), PAI-1, and collagen isoforms such as Col1a1, Col1a2, and Col4a1 (see, e.g., Neuman, et al., Can. J. Gastroenterol. Hepatol.2014, vol.28(11), p.607-618 and U.S.
• liver inflammation can also be assessed by change of macrophage infiltration, e.g., measuring a change of CD68 expression level.
• liver inflammation can be determined by measuring or monitoring serum levels or circulating levels of one or more of interleukin-(IL) 6, interleukin-(IL) 1 ⁇ , tumor necrosis factor (TNF)- ⁇ , transforming growth factor (TGF)- ⁇ , monocyte chemotactic protein (MCP)-1, and C-reactive protein (CRP).
• the level of one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis is determined for a sample from the subject prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof. In some embodiments, the level of one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis is determined during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• a decrease in the level of one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis during the period of time or after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof, compared to prior to administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof, indicates treatment of NASH.
• the decrease in the level of one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis following administration of the compound of formula (I), or a pharmaceutically acceptable salt thereof is by at least about 5%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, or at least about 99%.
• the level of one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis during the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof is by at least about 5%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, or at least about 99%.
• the level of one or more biomarkers indicative of one or more of liver damage, inflammation, liver fibrosis, and/or liver cirrhosis after the period of time of administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof is by at least about 5%, at least about 10%, at least about 15%, at least about 20%, at least about 25%, at least about 30%, at least about 35%, at least about 40%, at least about 45%, at least about 50%, at least about 55%, at least about 60%, at least about 65%, at least about 70%, at least about 75%, at least about 80%, at least about 85%, at least about 90%, at least about 95%, or at least about 99%.
• the treatment of NASH decreases the level of serum bile acids in the subject.
• the level of serum bile acids is determined by, for example, an ELISA enzymatic assay or the assays for the measurement of total bile acids as described in Danese et al., PLoS One.2017, vol.12(6): e0179200, which is incorporated by reference herein in its entirety.
• the level of serum bile acids can decrease by, for example, 10% to 40%, 20% to 50%, 30% to 60%, 40% to 70%, 50% to 80%, or by more than 90% of the level of serum bile acids prior to administration of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the NASH is NASH with attendant cholestasis.
• cholestasis the release of bile, including bile acids, from the liver is blocked.
• Bile acids can cause hepatocyte damage (see, e.g., Perez MJ, Briz O. World J. Gastroenterol.2009, vol.15(14), p.1677-1689) likely leading to or increasing the progression of fibrosis (e.g., cirrhosis) and increasing the risk of hepatocellular carcinoma (see, e.g., Sorrentino P et al., Dig. Dis. Sci.2005, vol.50(6), p.1130-1135 and Satapathy SK and Sanyal AJ. Semin.
• the treatment of NASH includes treatment of pruritus.
• the treatment of NASH with attendant cholestasis includes treatment of pruritus.
• a subject with NASH with attendant cholestasis has pruritus.
• Exemplary biomarkers for NASH are provided in Table 7. Table 7.
• a panel including ⁇ 2-macroglobulin, haptoglobin, apolipoprotein A1, bilirubin, gamma glutamyl transpeptidase (GGT) combined with a subject’s age and gender to generate a measure of fibrosis and necroinflammatory activity in the liver e.g., FIBROTEST®, FIBROSURE®
• a panel including bilirubin, gamma-glutamyltransferase, hyaluronic acid, ⁇ 2- macroglobulin combined with the subject’s age and sex e.g., HEPASCORE® 2
• the free fraction is greater than about 0.2%, such as greater than about 0.4%, such as greater than about 0.6%, such as greater than about 0.8%, such as greater than about 1.0%, such as greater than about 1.25%, such as greater than about 1.5%, such as greater than about 1.75%, such as greater than about 2.0%, such as greater than about 2.5%, such as greater than about 3%, such as greater than about 4%, such as greater than about 5%, such as greater than about 7.5%, such as greater than about 10%, or such as greater than about 20%.
• Some compounds of formula (I), or pharmaceutically acceptable salts thereof, may be excreted in urine.
• the fraction of the compound that is excreted in urine is greater than about 0.2%, such as greater than about 0.4%, such as greater than about 0.6%, such as greater than about 0.8%, such as greater than about 1.0%, such as greater than about 2%, such as greater than about 3%, such as greater than about 5%, such as greater than about 7.5%, such as greater than about 10%, such as greater than about 15%, such as greater than about 20%, such as greater than about 30%, or such as greater than about 50%.
• some compounds of formula (I), or pharmaceutically acceptable salts thereof may be circulated via the enterohepatic circulation.
• the fraction of the compound that is circulated via the enterohepatic circulation is greater than about 0.1%, such as greater than about 0.2%, such as greater than about 0.3%, such as greater than about 0.5%, such as greater than about 1.0%, such as greater than about 1.5%, such as greater than about 2%, such as greater than about 3%, such as greater than about 5%, such as greater than about 7%, such as greater than about 10%, such as greater than about 15%, such as greater than about 20%, such as greater than about 30% or such as greater than about 50%.
• Some compounds of formula (I), or pharmaceutically acceptable salts thereof may cause renal excretion of bile salts.
• the fraction of circulating bile acids that is excreted by the renal route is greater than about 1 %, such as greater than about 2%, such as greater than about 5%, such as greater than about 7%, such as greater than about 10%, such as greater than about 15%, such as greater than about 20%, or such as greater than about 25%.
• Some compounds of formula (I), or pharmaceutically acceptable salts thereof may show improved or optimal permeability.
• the permeability may be measured in Caco2 cells, and values are given as Papp (apparent permeability) values in cm/s.
• the permeability is greater than at least about 0.1 x 10 -6 cm/s, such as greater than about 0.2 x 10 -6 cm/s, such as greater than about 0.4 x 10 -6 cm/s, such as greater than about 0.7 x 10 -6 cm/s, such as greater than about 1.0 x 10 -6 cm/s, such as greater than about 2 x 10 -6 cm/s, such as greater than about 3 x 10 -6 cm/s, such as greater than about 5 x 10 -6 cm/s, such as greater than about 7 x 10 -6 cm/s, such as greater than about 10 x 10 -6 cm/s, such as greater than about 15 x 10 -6 cm/s.
• the oral bioavailability is greater than about 5%, such as greater than about 7%, such as greater than about 10%, such as greater than about 15%, such as greater than about 20%, such as greater than about 30%, such as greater than about 40%, such as greater than about 50 %, such as greater than about 60 %, such as greater than about 70% or such as greater than about 80%.
• the oral bioavailability is between about 10 and about 90%, such as between about 20 and about 80%, such as between about 30 and about 70% or such as between about 40 and about 60%.
• Some compounds of formula (I), or pharmaceutically acceptable salts thereof may be a substrate to relevant transporters in the kidney. Some compounds of formula (I), or pharmaceutically acceptable salts thereof, may give rise to concentrations of bile acids in the intestine, the liver and in serum that do not cause adverse gastrointestinal effects. Some compounds of formula (I), or pharmaceutically acceptable salts thereof, may decrease the concentration of bile acids in the liver without causing gastrointestinal disorders such as diarrhoea.
• the terms “treatment”, “treat” and “treating” refer to reversing, alleviating, delaying the onset of, or inhibiting the progress of a disease or disorder, or one or more symptoms thereof, as described herein.
• treatment may be administered after one or more symptoms have developed. In other embodiments, treatment may be administered in the absence of symptoms. For example, treatment may be administered to a susceptible individual prior to the onset of symptoms (e.g., in light of a history of symptoms and/or in light of genetic or other susceptibility factors). Treatment may also be continued after symptoms have resolved, for example to prevent or delay their recurrence.
• a suitable pharmaceutically acceptable salt of a compound of the invention is, for example, a base- addition salt of a compound of the invention which is sufficiently acidic, such as an alkali metal salt (e.g., a sodium or potassium salt), an alkaline earth metal salt (e.g., a calcium or magnesium salt), an ammonium salt, or a salt with an organic base which affords a physiologically acceptable cation, for example a salt with methylamine, dimethylamine, trimethylamine, piperidine, morpholine or tris-(2- hydroxyethyl)amine.
• Some compounds of formula (I), or pharmaceutically acceptable salts thereof may have chiral centres and/or geometric isomeric centres (E- and Z-isomers).
• the invention encompasses all such optical isomers, diastereoisomers and geometric isomers that possess ASBT and/or LBAT inhibitory activity.
• the invention also encompasses any and all tautomeric forms of compounds of formula (I), or pharmaceutically acceptable salts thereof, that possess ASBT and/or LBAT inhibitory activity.
• Certain compounds of formula (I), or pharmaceutically acceptable salts thereof may exist in unsolvated as well as solvated forms, such as, for example, hydrated forms. It is to be understood that the invention encompasses all such solvated forms that possess ASBT and/or LBAT inhibitory activity.
• the invention relates to a pharmaceutical composition
• a pharmaceutical composition comprising a therapeutically effective amount of a compound of formula (I), or a pharmaceutically acceptable salt thereof, and one or more pharmaceutically acceptable excipients.
• the excipients may e.g. include fillers, binders, disintegrants, glidants and lubricants.
• pharmaceutical compositions may be prepared in a conventional manner using conventional excipients.
• suitable fillers include, but are not limited to, dicalcium phosphate dihydrate, calcium sulfate, lactose (such as lactose monohydrate), sucrose, mannitol, sorbitol, cellulose, microcrystalline cellulose, dry starch, hydrolyzed starches and pregelatinized starch.
• the filler is mannitol and/or microcrystalline cellulose.
• suitable binders include, but are not limited to, starch, pregelatinized starch, gelatin, sugars (such as sucrose, glucose, dextrose, lactose and sorbitol), polyethylene glycol, waxes, natural and synthetic gums (such as acacia gum and tragacanth gum), sodium alginate, cellulose derivatives (such as hydroxypropylmethylcellulose (or hypromellose), hydroxypropylcellulose and ethylcellulose) and synthetic polymers (such as acrylic acid and methacrylic acid copolymers, methacrylic acid copolymers, methyl methacrylate copolymers, aminoalkyl methacrylate copolymers, polyacrylic acid/polymethacrylic acid copolymers and polyvinylpyrrolidone (povidone)).
• sugars such as sucrose, glucose, dextrose, lactose and sorbitol
• the binder is hydroxypropylmethylcellulose (hypromellose).
• suitable disintegrants include, but are not limited to, dry starch, modified starch (such as (partially) pregelatinized starch, sodium starch glycolate and sodium carboxymethyl starch), alginic acid, cellulose derivatives (such as sodium carboxymethylcellulose, hydroxypropyl cellulose, and low substituted hydroxypropyl cellulose (L-HPC)) and cross-linked polymers (such as carmellose, croscarmellose sodium, carmellose calcium and cross-linked PVP (crospovidone)).
• the disintegrant is croscarmellose sodium.
• glidants and lubricants include, but are not limited to, talc, magnesium stearate, calcium stearate, stearic acid, glyceryl behenate, colloidal silica, aqueous silicon dioxide, synthetic magnesium silicate, fine granulated silicon oxide, starch, sodium lauryl sulfate, boric acid, magnesium oxide, waxes (such as carnauba wax), hydrogenated oil, polyethylene glycol, sodium benzoate, polyethylene glycol, and mineral oil.
• the glidant or lubricant is magnesium stearate or colloidal silica.
• the pharmaceutical composition may be conventionally coated with one or more coating layers.
• the coating layers may comprise one or more coating agents, and may optionally comprise plasticizers and/or pigments (or colorants).
• suitable coating agents include, but are not limited to, cellulose-based polymers (such as ethylcellulose, hydroxypropylmethylcellulose (or hypromellose), hydroxypropylcellulose, cellulose acetate phthalate, cellulose acetate succinate, hydroxypropyl methylcellulose acetate succinate and hydroxypropyl methylcellulose phthalate), vinyl-based polymers (such as polyvinyl alcohol) and polymers based on acrylic acid and derivatives thereof (such as acrylic acid and methacrylic acid copolymers, methacrylic acid copolymers, methyl methacrylate copolymers, aminoalkyl methacrylate copolymers, polyacrylic acid/polymethacrylic acid copolymers).
• the coating agent is hydroxypropylmethylcellulose.
• the coating agent is polyvinyl alcohol.
• suitable plasticizers include, but are not limited to, triethyl citrate, glyceryl triacetate, tributyl citrate, diethyl phthalate, acetyl tributyl citrate, dibutyl phthalate, dibutyl sebacate and polyethylene glycol.
• the plasticizer is polyethylene glycol.
• suitable pigments include, but are not limited to, titanium dioxide, iron oxides (such as yellow, brown, red or black iron oxides) and barium sulfate.
• the pharmaceutical composition may be in a form that is suitable for oral administration, for parenteral injection (including intravenous, subcutaneous, intramuscular and intravascular injection), for topical administration of for rectal administration.
• the pharmaceutical composition is in a form that is suitable for oral administration, such as a tablet or a capsule.
• the dosage required for the therapeutic or prophylactic treatment will depend on the route of administration, the severity of the disease, the age and weight of the patient and other factors normally considered by the attending physician, when determining the appropriate regimen and dosage level for a particular patient.
• the amount of the compound to be administered will vary for the patient being treated, and may vary from about 1 ⁇ g/kg of body weight to about 50 mg/kg of body weight per day.
• a unit dose form such as a tablet or capsule, will usually contain about 1 to about 250 mg of active ingredient, such as about 1 to about 100 mg, or such as about 1 to about 50 mg, or such as about 1 to about 20 mg, e.g. about 2.5 mg, or about 5 mg, or about 10 mg, or about 15 mg.
• the daily dose can be administered as a single dose or divided into one, two, three or more unit doses.
• An orally administered daily dose of a bile acid modulator is preferably within about 0.1 to about 250 mg, more preferably within about 1 to about 100 mg, such as within about 1 to about 5 mg, such as within about 1 to about 10 mg, such as within about 1 to about 15 mg, or such as within about 1 to about 20 mg.
• the invention relates to a compound of formula (I) wherein R 1 and R 2 are each independently C 1-4 alkyl; R 3 is independently selected from the group consisting of hydrogen, halogen, hydroxy, C 1-4 alkyl, C 1-4 haloalkyl, C 1-4 alkoxy, C 1-4 haloalkoxy, cyano, nitro, amino, N-(C 1-4 alkyl)amino, N,N-di(C 1-4 alkyl)amino, and N-(aryl-C 1-4 alkyl)amino; n is an integer 1, 2 or 3; R 4 is selected from the group consisting of hydrogen, halogen, hydroxy, cyano, C 1-4 alkyl, C 3-6 cycloalkyl, C 1-4 alkoxy, C 3-6 cycloalkyloxy, C 1-4 alkylthio, C 3-6 cycloalkylthio, amino, N-(C 1-4 alkyl)amino and N,N
• the invention relates to a compound of formula (I), or a pharmaceutically acceptable salt thereof, for use in the treatment or prevention of any of the diseases recited herein.
• the invention also relates to the use of a compound of formula (I), or a pharmaceutically acceptable salt thereof, in the manufacture of a medicament for the treatment or prevention of any of the diseases recited herein.
• the invention also relates to a method of treating or preventing any of the diseases recited herein in a subject, such as man, comprising administering to the subject in need of such treatment or prevention a therapeutically effective amount of a compound of formula (I), or a pharmaceutically acceptable salt thereof.
• the compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with at least one other therapeutically active agent, such as with one, two, three or more other therapeutically active agents.
• the compound of formula (I), or a pharmaceutically acceptable salt thereof, and the at least one other therapeutically active agent may be administered simultaneously, sequentially or separately.
• Therapeutically active agents that are suitable for combination with the compounds of formula (I) include, but are not limited to, known active agents that are useful in the treatment of any of the aforementioned conditions, disorders and diseases.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with another ASBT inhibitor.
• Suitable ASBT inhibitors are disclosed in WO 93/16055, WO 94/18183, WO 94/18184, WO 96/05188, WO 96/08484, WO 96/16051, WO 97/33882, WO 98/03818, WO 98/07449, WO 98/40375, WO 99/35135, WO 99/64409, WO 99/64410, WO 00/47568, WO 00/61568, WO 00/38725, WO 00/38726, WO 00/38727, WO 00/38728, WO 00/38729, WO 01/66533, WO 01/68096, WO 02/32428, WO 02/50051, WO 03/020710, WO 03/022286, WO 03/022825, WO 03/022830, WO 03/061663, WO 03/091232, WO 03/106482, WO 2004/006899,
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a bile acid binder (also referred to as a bile acid sequestrant, or a resin), such as colesevelam, cholestyramine or cholestipol.
• a bile acid binder also referred to as a bile acid sequestrant, or a resin
• colesevelam, cholestyramine or cholestipol a bile acid binder
• the bile acid binder is formulated for colon release. Examples of such formulations are disclosed in e.g. WO 2017/138877, WO 2017/138878, WO 2019/032026 and WO 2019/032027, all of which are incorporated herein by reference in their entireties.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a DPP-IV inhibitor, including gliptins such as sitagliptin, vildagliptin, saxagliptin, linagliptin, gemigliptin, anagliptin, teneligliptin, alogliptin, trelagliptin, omarigliptin, evogliptin, gosogliptin and dutogliptin, or a pharmaceutically acceptable salt thereof.
• gliptins such as sitagliptin, vildagliptin, saxagliptin, linagliptin, gemigliptin, anagliptin, teneligliptin, alogliptin, trelagliptin, omarigliptin, evogliptin, gosogliptin and dutogliptin, or a pharmaceutical
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an HMG CoA reductase inhibitor, such as fluvastatin, lovastatin, pravastatin, simvastatin, atorvastatin, pitavastatin cerivastatin, mevastatin, rosuvastatin, bervastatin or dalvastatin, or a pharmaceutically acceptable salt thereof.
• an HMG CoA reductase inhibitor such as fluvastatin, lovastatin, pravastatin, simvastatin, atorvastatin, pitavastatin cerivastatin, mevastatin, rosuvastatin, bervastatin or dalvastatin, or a pharmaceutically acceptable salt thereof.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a cholesterol absorption inhibitor such as ezetimibe, or a pharmaceutically acceptable salt thereof.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a PPAR alpha agonist, including fibrates such as clofibrate, bezafibrate, ciprofibrate, clinofribrate, clofibride, fenofibrate, gemfibrozil, ronifibrate and simfribrate, or a pharmaceutically acceptable salt thereof.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a PPAR gamma agonist, including thiazolidinediones such as pioglitazone, rosiglitazone and lobeglitazone, or a pharmaceutically acceptable salt thereof.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a dual PPAR alpha/gamma agonist, including glitazars such as saroglitazar, aleglitazar, muraglitazar or tesaglitazar, or a pharmaceutically acceptable salt thereof.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a dual PPAR alpha/delta agonist, such as elafibranor.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a pan PPAR agonist (i.e.
• a PPAR agonist that has activity across all subtypes: ⁇ , ⁇ and ⁇ ), such as IVA337.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a farnesoid X receptor (FXR) modulators, including FXR agonists such as cafestol, chenodeoxycholic acid, 6 ⁇ -ethyl-chenodeoxycholic acid (obeticholic acid; INT-747), fexaramine, tropifexor, cilofexor and MET409.
• FXR farnesoid X receptor
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a TGR5 receptor modulator, including TGR5 agonists such as 6 ⁇ - ethyl-23(S)-methylcholic acid (INT-777).
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a dual FXR/TGR5 agonist such as INT-767.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with ursodeoxycholic acid (UDCA).
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with nor-ursodeoxycholic acid (nor-UDCA).
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an FGF19 modulator, such as NGM282.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an FGF21 agonist, such as BMS-986036.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an integrin inhibitor, such as PLN-74809 and PLN-1474.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a CCR2/CCR5 inhibitor, such as cenicriviroc.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a caspase protease inhibitor, such as emricasan.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a galectin-3 inhibitor, such as GR-MD-02.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a stearoyl-CoA desaturase (SCD) Inhibitor, such as aramchol (arachidyl amido cholanoic acid).
• SCD stearoyl-CoA desaturase
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an apoptosis signal-regulating kinase 1 (ASK1) inhibitor, such as selonsertib.
• ASK1 apoptosis signal-regulating kinase 1
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an LOXL2 inhibitor, such as suppressuzumab.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an ACC inhibitor, such as GS-0976.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a thyroid hormone receptor- ⁇ agonist, such as MGL3196.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a GLP-1 agonist such as liraglutide.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a dual glucagon-like peptide and glucagon receptor agonists, such as SAR425899.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a mitochondrial pyruvate carrier inhibitor, such as MSDC-0602K.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an anti-oxidant agent, such as vitamin E.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an SGLT1 inhibitor, an SGLT2 inhibitor or a dual SGLT1 and SGLT2 inhibitor.
• examples of such compounds are dapagliflozin, sotagliflozin, canagliflozin, empagliflozin, LIK066 and SGL5213.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a diacylglycerol O-Acyltransferase 2 (DGAT2) inhibitor, such as DGAT2RX and PF-06865571.
• DGAT2 diacylglycerol O-Acyltransferase 2
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a fatty acid synthase (FASN) Inhibitor, such as TVB-2640.
• FSN fatty acid synthase
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an AMP-activated protein kinase (AMPK) activator, such as PXL- 770.
• AMPK AMP-activated protein kinase
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a glucocorticoid receptor antagonist (GR), a mineralocorticoid receptor antagonist (MR), or a dual GR/MR antagonist. Examples of such compounds are MT-3995 and CORT-118335.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a cannabinoid receptor 1 (CB1) antagonist, such as IM102.
• CB1 cannabinoid receptor 1
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a Klotho ⁇ (KLB) and fibroblast growth factor receptor (FGFR) activator, such as MK-3655 (previously known as NGM-313).
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a chemokine (c-c motif) ligand 24 (CCL24) inhibitor, such as CM101.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an A3 antagonist, such as PBF-1650.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a P2x7 receptor antagonist, such as SGM 1019.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with P2Y13 receptor agonists, such as CER-209.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a sulfated oxysterol, such as Dur-928.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a leukotriene D4 (LTD4) receptor antagonist, such as MN-001.
• LTD4 leukotriene D4
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a type 1 natural killer T cell (NKT1) inhibitor, such as GRI-0621.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an anti-lipopolysaccharide (LPS) compound, such as IMM-124E.
• LPS anti-lipopolysaccharide
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a VAP1 inhibitor, such as BI1467335.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an A3 adenosine receptor agonist, such as CF-102.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a SIRT-1 activator, such as NS-20.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a nicotinic acid receptor 1 agonist, such as ARI-3037MO.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a TLR4 antagonist, such as JKB-121.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a ketohexokinase inhibitor, such as PF-06835919.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an adiponectin receptor agonist, such as ADP-335.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with an autotaxin inhibitor, such as PAT-505 and PF8380.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a chemokine (c-c motif) receptor 3 (CCR3) antagonist, such as bertilimumab.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a chloride channel stimulator, such as cobiprostone and lubiprostone.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a heat shock protein 47 (HSP47) inhibitor, such as ND-L02-s0201.
• HSP47 heat shock protein 47
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a sterol regulatory element-binding protein (SREBP) transcription factor inhibitor, such as CAT-2003 and MDV-4463.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a biguanidine, such as metformin.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with insulin.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a glycogen phosphorylase inhibitor and/or a glucose-6- phosphatase inhibitor.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a sulfonylurea, such as glipizid, glibenklamid and glimepirid.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a meglitinide, such as repaglinide, nateglinide and ormiglitinide.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a glucosidase inhibitor, such as acarbose or miglitol.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a squalene synthase inhibitor, such as TAK-475.
• compounds of formula (I), or pharmaceutically acceptable salts thereof are administered in combination with a PTPB1 inhibitor, such as trodusquemine, ertiprotafib, JTT-551 and claramine.
• a PTPB1 inhibitor such as trodusquemine, ertiprotafib, JTT-551 and claramine.
• LCMS Instrument name: Agilent 1290 infinity II.
• Method A Mobile phase: A: 0.1% HCOOH in H 2 O: ACN (95:5), B: ACN; flow rate: 1.5 mL/min; column: ZORBAX XDB C-18 (50 x 4.6 mm) 3.5 ⁇ M.
• Method B Mobile phase: A: 10 mM NH4HCO3 in water, B: ACN; flow rate: 1.2 mL/min; column: XBridge C8 (50 x 4.6 mm), 3.5 ⁇ M.
• Method I Mobile phase: A: 0.1% HCOOH in water: ACN (95:5), B: ACN; flow Rate: 0.8 mL/min; Column: ZORBAX ECLIPSE PLUS C18 (2.1 x 50) mm, 1.8 ⁇ m.
• UPLC Instrument name: waters Acquity I Class Method A: Mobile Phase: A: 0.1% HCOOH in water, B: 0.1% HCOOH in ACN; Flow Rate: 0.8 mL/min; Column: Acquity UPLC HSS T3 (2.1 x 50) mm; 1.8 ⁇ m.
• HPLC Instrument name: Agilent 1260 Infinity II series instruments as followed using % with UV detection (maxplot).
• Method A Mobile phase: A: 10 mM NH4HCO3 in water, B: ACN; flow rate: 1.0 mL/min; column: XBridge C8 (50 x 4.6 mm, 3.5 ⁇ m).
• Method B Mobile phase: A: 0.1% TFA in water, B: 0.1% TFA in ACN; flow rate: 2.0 mL/min; column: XBridge C8 (50 x 4.6 mm, 3.5 ⁇ m).
• Method C Mobile phase: A: 10 mM NH4OAc in milli-q water, B: ACN; flow rate: 1.0 ml/min; column: Phenomenex Gemini C18 (150 x 4.6 mm, 3.0 ⁇ m).
• Method D Mobile phase: A: 0.1% TFA in water, B: ACN; flow rate: 1.0 mL/min; column: ATLANTIS dC18 (250 x 4.6 mm, 5.0 ⁇ m).
• Method E Mobile phase: A: 0.1% TFA in water, B: ACN, flow rate: 2.0 mL/ min; column: X-Bridge C8 (50 X 4.6 mm, 3.5 ⁇ m).
• Method C Mobile Phase: 20 mM ammonia in methanol; flow rate: 3 mL/min; column: YMC Cellulose-SC (250 x 4.6 mm, 5 ⁇ m).
• Method D Mobile Phase: methanol; flow rate: 3 mL/min; column: Lux A1 (250 x 4.6 mm, 5 ⁇ m).
• Method E Mobile Phase: 0.5% isopropylamine in methanol; flow rate: 5 mL/min; column: Lux C4.
• Method F Mobile Phase: 0.5% isopropylamine in methanol; flow rate: 3 mL/min; column: YMC Cellulose-SC.
• Method G Mobile Phase: 0.5% isopropylamine in methanol; flow rate: 3 mL/min; column: Lux A1.
• Method H Mobile Phase: 0.5% isopropylamine in IPA; flow rate: 3 mL/min; column: Lux A1 (250 x 4.6 mm, 5 ⁇ m).
• Method I Mobile phase: 0.5% isopropylamine in methanol; flow rate: 3 mL/min; column: Chiral CCS (250 x 4.6 mm, 5 ⁇ m).
• Method J Mobile Phase: 0.5% isopropylamine in IPA; flow rate: 5 mL/min; column: YMC Cellulose-SC AD-H (250 x 4.6 mm, 5 ⁇ m).
• Method K Mobile phase: 0.5% Isopropylamine in methanol; flow rate: 4 mL/min; column: (R,R)- Whelk-01 (250 x 4.6 mm, 5 ⁇ m).
• Method L Mobile phase: 0.5% Isopropylamine in IPA; flow rate: 3 mL/min; column: Chiralcel OX-H (250 x 4.6 mm, 5 ⁇ m).
• Method M Mobile phase: 0.5% Isopropylamine in IPA; flow rate: 5 mL/min; column: YMC Cellulose- SC (250 x 4.6 mm, 5 ⁇ m).
• Method C Mobile phase: A: 10 mM NH 4 HCO 3 in water; B: ACN; flow rate: 1.0 mL/min; column: XBridge C8 (50 x 4.6 mm, 3.5 ⁇ m).
• Method D Mobile phase: A: 0.1% HCOOH in water; B: ACN; flow rate: 1.0 mL/min; column: X-select C18 (30 x 150 mm, 5 ⁇ m).
• Tetrakis(triphenylphosphine)palladium(0) (0.96 g, 0.83 mmol) was added and the reaction mixture was heated at 100 °C for 24 hours. After completion of the reaction (monitored by TLC), the reaction mixture was poured into ice-cold water (25 mL) and the aqueous layer was extracted with EtOAc (2 x 50 mL). The combined organic layer was washed with ice-cold water (30 mL), brine (30 mL) and dried over anhydrous Na2SO4. The organic part was concentrated under vacuum and the resulting crude was purified by Isolera column chromatography (eluent: 90-100% EtOAc/PE; silica gel: 230-400 mesh) to afford the title compound.
• Tris[2-(2-methoxyethoxy)ethyl]amine (0.56 mL, 0.017 mol) was then added under nitrogen atmosphere and the resulting reaction mixture was heated for 40 hours to 135 °C. After completion of the reaction (monitored by UPLC), the reaction mixture was filtered through celite and the celite pad was washed with EtOAc (100 mL). The filtrate was washed with water (50 mL) and brine (50 mL) and dried over anhydrous Na2SO4. The organic part was concentrated under vacuum to obtain the crude material which was purified by Isolera column chromatography (eluent: 3-5% EtOAc/PE; silica gel: 230-400 mesh) to afford the title compound.
• Tris[2-(2-methoxyethoxy)ethyl]amine (0.86 g, 0.0026 mol) was then added under nitrogen atmosphere and the resulting reaction mixture was heated for 40 h at 135 °C. After completion of the reaction (monitored by UPLC), the reaction mixture was filtered through celite and the celite pad was washed with EtOAc (15 mL). The filtrate was concentrated under vacuum to obtain the crude material which was purified by Isolera column chromatography (eluent: 3-5% EtOAc/PE; silica gel: 230-400 mesh) to afford the title compound. Yield: 70.6% (4.1 g, pale brown solid).
• Tris[2-(2-methoxyethoxy)ethyl]amine (1.3 mL, 4.0 mmol) was then added under nitrogen atmosphere and the resulting reaction mixture was heated for 16 hours at 135 °C. After completion of the reaction (monitored by TLC), the reaction mixture was filtered through celite and the celite pad was washed with EtOAc (200 mL). The filtrate was washed with water (100 mL) and brine (75 mL) and dried over anhydrous Na2SO4. The resulting crude material was purified by Isolera column chromatography (eluent: 5% EtOAc/PE; silica gel: 230-400 mesh) to afford the title compound. Yield: 64% (12.2 g, off-white solid).
• the material was concentrated under vacuum at 40 °C.
• the first eluting fraction corresponded to enantiomer 1 and the second eluting fraction corresponded to enantiomer 2.
• the absolute configuration of the two enantiomers is not known.
• Each of the two fractions was then individually treated for further purification.
• the obtained residue was acidified with dilute HCl (1.5 N, pH ⁇ 4) and the aqueous layer was extracted with EtOAc (3 x 5 mL).
• the combined organic layer was washed with water (10 mL) and brine (10 mL) and dried over anhydrous Na2SO4.
• the organic part was filtered and concentrated under vacuum at 40 °C to afford A purified enantiomer of the title compound.
• Enantiomer 1 Yield: 37% (100 mg, white solid).
• Enantiomer 1 Yield: 48% (290 mg, white solid).
• Enantiomer 2 Yield: 48% (311 mg, off-white solid).
• tert-butyl 2-bromoacetate (65 mg, 0.33 mmol) was added dropwise at 0°C and stirred 16 h at 70 °C. After completion of the reaction (monitored by TLC), the reaction mixture was quenched with dilute HCl (1.5 N, 2 mL), diluted with water (5 mL). The aqueous layer was extracted with EtOAc (2 x 20 mL), then the combined organic layer was washed with water (5 mL) and brine solution (5 mL). The organic part was dried over anhydrous Na2SO4, filtered and concentrated under vacuum to afford the title compound. The obtained crude material was forwarded as such to the next step without any further purification.
• Enantiomer 2 of the title compound was obtained following the same procedure, starting from 100 mg of enantiomer 2 of Intermediate 60.
• the resulting crude material was purified by Isolera column chromatography (eluent: 15% EtOAc/PE; silica gel: 230-400 mesh) to afford the title compound.
• Enantiomer 1 Yield: 140 mg (crude, off-white solid).
• Example 1 2-((3,3-dibutyl-7-(dimethylamino)-1,1-dioxido-5-phenyl-2,3,4,5-tetrahydro-1,5-benzothiazepin-8- yl)oxy)acetic acid
• methyl 2-((3,3-dibutyl-7-(dimethylamino)-1,1-dioxido-5-phenyl-2,3,4,5- tetrahydro-1,5-benzothiazepin-8-yl)oxy)acetate (Intermediate 3; 0.14 g, 0.27 mmol) in a mixture of 1,4-dioxane and water (5 mL, 4:1) at 0 °C, lithium hydroxide (23 mg, 0.54 mmol) was added and the reaction mixture was stirred at room temperature for 4 hours.
• Enantiomer 1 Yield: 29% (16 mg, white solid).
• Example 12 2-((3-butyl-3-ethyl-7-fluoro-1,1-dioxido-5-phenyl-2,3,4,5-tetrahydro-1,5-benzothiazepin-8- yl)oxy)acetic acid
• tert-butyl 2-((3-butyl-3-ethyl-7-fluoro-1,1-dioxido-5-phenyl-2,3,4,5- tetrahydro-1,5-benzothiazepin-8-yl)oxy)acetate (Intermediate 38; 0.56 g, 1.10 mmol) in DCM (5 mL) at 0 °C, TFA (3.36 mL, 6 vol) was added and the reaction mixture was stirred for 3 hours at room temperature.
• Enantiomer 1 Yield: 78% (70 mg, white solid).
• LCMS (Method D) 496.2 (M + +H), Rt.2.59 min, 98.06% (Max).
• Examples 17 and 18 2-((3-butyl-3-ethyl-5-(4-hydroxyphenyl)-7-(methylthio)-1,1-dioxido-2,3,4,5-tetrahydro-1,5- benzothiazepin-8-yl)oxy)acetic acid and 2-((3-butyl-3-ethyl-5-(4-methoxyphenyl)-7-(methylthio)- 1,1-dioxido-2,3,4,5-tetrahydro-1,5-benzothiazepin-8-yl)oxy)acetic acid To a stirred solution of a mixture of methyl 2-((3-butyl-3-ethyl-5-(4-hydroxyphenyl)-7-(methylthio)- 1,1-dioxido-2,3,4,5-tetrahydro-1,5-benzothiazepin-8-yl)oxy)acetate and methyl 2-((3-butyl-3-ethyl-5- (4-methoxyphenyl)
• reaction mixture was stirred for 1.5 hours below -10 °C and then for 1.5 hours at room temperature. After completion of the reaction (monitored by TLC and UPLC), the reaction mixture was quenched with ice water (5 mL) and the aqueous layer was extracted with DCM (2 x 20 mL). The combined organic layers were washed with water (5 mL) and brine (5 mL) and dried over anhydrous Na 2 SO 4 . The organic part was filtered, concentrated under vacuum and the resulting crude material was purified by trituration with ethyl acetate and petroleum ether (2 x 3 mL) to afford enantiomer 1 of the title compound.
• Enantiomer 2 of the title compound was obtained following the same procedure, starting from 100 mg of enantiomer 2 of Intermediate 63. The absolute configuration of the two enantiomers is not known. Enantiomer 1: Yield: 35% (42 mg, off-white solid).
• BIOLOGICAL ASSAYS IBAT (h/m) assay protocol 10,000 cells (Human or Mouse IBAT-overexpressing cells) were seeded in 96-wells plate (Corning CLS3809) in 200 ⁇ L MEM-alpha medium (Gibco 12571-063) supplemented with 10% FBS (Gibco 10438026) containing Puromycin (Gibco A1113803) (10 ⁇ g/mL) and incubated at 37 °C in 5% CO 2 for 48 hours. After incubation, media was decanted from the wells and cells were washed two times with 300 ⁇ L of basal MEM-alpha medium (FBS-free).
• test inhibitor dilutions (highest test concentration being 10 ⁇ M, 3-fold serial dilution, 10 points) prepared in DMSO (Sigma D2650) were added in incubation mix (maintaining 0.2% final DMSO concentration) containing 0.25 ⁇ M 3H-taurocholic acid (ARC ART-1368) and 5 ⁇ M of cold taurocholic acid (Sigma T4009).50 ⁇ L of incubation mix containing test inhibitors was then added to the wells (in duplicate) and the plates were incubated for 20 minutes in a CO 2 incubator at 37 °C.
• MicroScint-20 (PerkinElmer 6013621) was added to the wells and kept overnight at room temperature before reading the plates in TopCount NXTTM Microplate Scintillation and Luminescence Counter from PerkinElmer under 3H Test protocol (set at 120 seconds reading time per well).
• LBAT (h/m) assay protocol 20,000 cells (Human or Mouse LBAT-overexpressing cells) were seeded in 96-wells plate (Corning CLS3809) in 100 ⁇ L MEM-alpha medium (Gibco 12571-063) supplemented with 10% FBS (Gibco 10438026) containing Geneticin (Gibco 10131-027) (1 mg/mL) and incubated at 37 °C in 5% CO 2 for 24 hours. After incubation, media was decanted from the wells and cells were washed two times with 300 ⁇ L of basal MEM-alpha medium (FBS-free).
• incubation mix was prepared by adding test inhibitor dilutions (3- fold serial dilution in DMSO, 10 points) in MEM-alpha (without FBS) containing 0.3 ⁇ M 3H-taurocholic acid and 25 ⁇ M cold taurocholic acid maintaining 0.2% final DMSO concentration). 50 ⁇ L of incubation mix containing test inhibitors was then added to the wells (in duplicate) and the plates were incubated for 20 minutes in a CO 2 incubator at 37 °C. After incubation, the reaction was stopped by keeping the plates on ice water mix for 2-3 minutes and then the incubation mix was aspirated completely from the wells.
• Bidirectional permeability assay Caco-2 cells
• Caco-2 cells (Evotec) were seeded at a density of 70,000 cells/well in Millicell® 24-well cell culture insert plates and maintained in an incubator (37 °C, 5% CO 2 , 95% RH) for 21 days with media change on alternate days.
• Stock solutions (10 mM) of the test compounds, atenolol (low permeability marker), propranolol (high permeability marker) and digoxin (substrate for P-gp transport pathway) were prepared in dimethylsulfoxide (DMSO).
• An intermediate stock solution (1 mM) was prepared by diluting 10 ⁇ L of 10 mM master stock solution with 90 ⁇ L of neat DMSO.
• a working stock solution (10 ⁇ M) was prepared by diluting 50 ⁇ L of 1 mM with 4950 ⁇ L of FaSSIF buffer. Post addition of compounds to the FaSSIF, samples were subjected to sonication for 2 hours, and centrifuged at 4000 RPM for 30 minutes at 37 °C. The 4 mL of resultant supernatant was directly used in the assay. The final DMSO concentration in the transport experiments was 1%. On the day of assay, Caco-2 monolayers were washed twice with transport buffer (HBSS, pH 7.4) and pre-incubated for 30 min (37 °C, 5% CO2, 95% RH) in an incubator. The electrical resistance of the monolayers was measured with a Millicell® - ERS system.
• Monolayers with trans-epithelial electrical resistance (TEER) values greater than 350 ohm.cm 2 were selected for the assay.
• the assay was conducted in absorptive direction (A2B) and secretory (B2A) directions.
• Drug free HBSS buffer (pH 7.4) containing 1% bovine serum albumin (BSA) was introduced to the receiver (A-B-basolateral; B-A- Apical) compartments.
• the volumes of apical and basolateral compartments were 0.4 and 0.8 mL, respectively.
• plates were incubated in an incubator for 120 minutes at 37 °C.
• donor and receiver samples were collected and matrix matched (1:1, 30 ⁇ L study sample + 30 ⁇ L blank buffer) with the opposite buffer.
• Dosing samples matrix matched (1:1, 30 ⁇ L study sample + 30 ⁇ L blank buffer) with the opposite buffer.
• Samples were processed by adding acetonitrile containing internal standard (60 ⁇ L study sample + 200 ⁇ L acetonitrile containing internal standard -Tolbutamide, 500 ng/mL). Samples were vortexed and centrifuged at 4000 rpm for 10 minutes.
• the obtained supernatant (100 ⁇ L) was diluted with 100 ⁇ L of water and transferred to fresh 96 well plates.
• the concentration of compounds in the samples was analyzed by liquid chromatography tandem mass spectrometry (LC- MS/MS) method using discovery grade bio-analytical method, as applicable.
• HepaRG-based assay protocol A cryopreserved vial of differentiated HepaRG cells (Biopredic International HPR116080) is thawed in HepaRG Thawing/Plating/General Purpose Medium (Biopredic International ADD670C) supplemented with 200 mM Glutamax (Gibco 35050061) following the protocol provided by Biopredic International.70,000 cells per well are seeded in 96-wells plate (Corning CLS3809) in 100 ⁇ L of HepaRG Thawing/Plating/General Purpose Medium supplemented with 200 mM Glutamax and incubated at 37 °C in 5% CO2 for 24 hours.
• the seeding media is replaced by HepaRG Maintenance/Metabolism Medium (Biopredic International ADD620C) and incubated for 6 days, with fresh HepaRG Maintenance/Metabolism Medium replenishment every 48 hours.
• HepaRG Maintenance/Metabolism Medium Biopredic International ADD620C
• incubation media is decanted from the wells and cells are washed two times with 250 ⁇ L of William's E Basal Media (Gibco 12551032). After decanting William's E Basal Media each time, plates are tapped against paper towel to ensure maximum removal of residual media.
• Incubation mix is prepared by adding test inhibitor dilutions (3-fold serial dilution in DMSO (Sigma D2650)) in William's E media (basal) containing 0.3 ⁇ M 3H-taurocholic acid (ARC ART-1368) and 7.5 ⁇ M cold taurocholic acid (Sigma T4009) (maintaining 0.2% final DMSO concentration).50 ⁇ l of incubation mix containing test inhibitors is then added to the wells (in duplicate) and the plates are incubated for 30 minutes in 5% CO2 incubator at 37 °C. After incubation, the reaction is stopped by keeping the plates on ice water mix for 2-3 minutes and the incubation mix is then aspirated completely from the wells.
• test compound dilutions All test compounds were provided in powder form at room temperature.10 mM DMSO stocks of the test compounds were prepared, aliquoted and stored at -20 °C. From the 10 mM DMSO stock of the compounds, a 3-fold serial dilution in DMSO was prepared to get a total of 10 dilutions of the test compounds.0.5 ⁇ L of this dilution in DMSO was added to 250 ⁇ L of FBS-free basal media containing 3H-taurocholic acid and cold taurocholic acid to prepare the incubation mixture. Bioavailability studies Male mice (C57BL/6 or CD1) or Wistar rats of 8-9 weeks old were used. For each test compound, two groups of 3 animals each were used.
• One group was administered a single intravenous dose of 1 mg/kg (vehicle 100% DMSO) through the tail vein and the other group was administered a single oral dose of 10 mg/kg through gavage needle.
• the group that was administered an oral dose was fasted overnight.
• Blood samples were collected after 0.083, 0.25, 0.5, 1, 2, 4, 6, 8 and 24 hours following intravenous administration, and after 0.25, 0.5, 1, 2, 4, 6, 8 and 24 hours following oral administration. Blood samples were taken from saphenous vein.0.2% EDTA was used as the anticoagulant.
• the samples were analyzed by a discovery grade bioanalytical method developed for the estimation of test compound in plasma, using an LC-MS/MS system. Results Biological data for the compounds of the examples is shown in Table 8 below.
• Table 8 PD model Evaluation of test compound on total bile acids levels in male C57BL6 mice. C57BL/6N Tac mice of 8-9 weeks old are used to study the effect of bile acid modulators on bile acid levels. After completion of quarantine and acclimatization period, animals are randomized based on bodyweight into x experimental groups: (i) vehicle control, and (ii) test compound y mg/kg po once daily. Animals are treated with test compound for 7 days. On day 5 of the study, animals are individually housed in fresh cages. On day 7, feces are collected from each cage, followed by blood withdrawal from each animal through retro-orbital route. Animals are euthanized to collect liver and terminal ileum from each animal for further analysis.
• Bodyweight and food consumption are measured twice weekly. Serum lipid profiles are analyzed in serum samples of day 7. Total bile acids in serum is measured in the serum samples of day 7. Fecal bile excretion is measured in the fecal sample of day 7. Hepatic expression of CYP7A1 and SHP are quantified in the liver samples of day 7. Liver triglycerides and total cholesterol are analyzed in the liver samples of day 7.
• Urine bile acid model Evaluation of test compounds on urine bile acid levels in male C57BL/6N mice. C57BL/6N Tac mice of 8-9 weeks old are used to study the effect of bile acid modulators on bile acid levels.
• mice are randomized based on bodyweight into x experimental groups: (i) vehicle control, and (ii) test compound y mg/kg po once daily. Animals are treated with test compound for 7 days. On day 6 of the study, animals are transferred to a metabolic cage. On day 7, feces and urine are collected from each metabolic cage, followed by blood withdrawal from each animal through retro-orbital route. Animals are euthanized to collect kidney from each animal for further analysis. Bodyweight is measured twice weekly. Total bile acids in serum is measured in serum samples of day 7. Fecal bile acid excretion is measured in the fecal sample of day 7. Urine excretion of bile acids is measured in the sample of day 7. Kidney expression of ASBT, OSTa, OSTAb and MRP2 is quantified in the samples of day 7.

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