WO2022183281A1 - Composés et traitements de la dystrophie musculaire - Google Patents

Composés et traitements de la dystrophie musculaire Download PDF

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WO2022183281A1
WO2022183281A1 PCT/CA2022/050283 CA2022050283W WO2022183281A1 WO 2022183281 A1 WO2022183281 A1 WO 2022183281A1 CA 2022050283 W CA2022050283 W CA 2022050283W WO 2022183281 A1 WO2022183281 A1 WO 2022183281A1
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chkb
mice
choline
muscle
ppar
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PCT/CA2022/050283
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Christopher R. Mcmaster
Mahtab Tavasoli
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Mcmaster Christopher R
Mahtab Tavasoli
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Publication of WO2022183281A1 publication Critical patent/WO2022183281A1/fr

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    • 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
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/192—Carboxylic acids, e.g. valproic acid having aromatic groups, e.g. sulindac, 2-aryl-propionic acids, ethacrynic acid 
    • 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
    • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
    • A61K31/19—Carboxylic acids, e.g. valproic acid
    • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
    • 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
    • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
    • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
    • A61K31/216—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acids having aromatic rings, e.g. benactizyne, clofibrate
    • 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
    • A61K31/41—Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having five-membered rings with two or more ring hetero atoms, at least one of which being nitrogen, e.g. tetrazole
    • A61K31/425—Thiazoles
    • A61K31/426—1,3-Thiazoles
    • 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
    • A61K31/70—Carbohydrates; Sugars; Derivatives thereof
    • A61K31/7042—Compounds having saccharide radicals and heterocyclic rings
    • A61K31/7052—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides
    • A61K31/706—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom
    • A61K31/7064—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines
    • A61K31/7068—Compounds having saccharide radicals and heterocyclic rings having nitrogen as a ring hetero atom, e.g. nucleosides, nucleotides containing six-membered rings with nitrogen as a ring hetero atom containing condensed or non-condensed pyrimidines having oxo groups directly attached to the pyrimidine ring, e.g. cytidine, cytidylic acid

Definitions

  • Muscular dystrophy congenital, megaconial type (OMIM 602541; www.omim.org) is an autosomal recessive dystrophy caused by loss of function of the CHKB gene and can cause a muscular dystrophy.
  • the most common types of muscular dystrophy result from mutations in genes coding for members of protein complexes which act as linkers between the cytoskeleton of the muscle cell and the extracellular matrix that provides mechanical support to the plasma membrane during myofiber contraction. Muscular dystrophies result in fibrofatty replacement of muscle tissue, progressive muscle weakness, functional disability and often early death.
  • PC Phosphatidylcholine
  • Choline kinase catalyzes the phosphorylation of choline to phosphocholine and is the first enzymatic step in the synthesis of PC.
  • CHKA and CHKB Monomeric choline kinase proteins combine to form homo- or hetero-dimeric active forms.
  • CHKA and CHKB proteins share similar structures and enzyme activity but display some distinct molecular structural domains and differential tissue expression patterns. Knock-out of the murine Chka gene leads to embryonic lethality.
  • Clikb deficient mice are viable, but noticeably smaller than their wild type counterparts, and show severe bowing of the ulna and radius at birth.
  • Chkb -/- mice lose hindlimb motor control, while the forelimbs are spared.
  • Inactivation of the Clikb gene in mice would be predicted to decrease PC level, however, reports indicate no, or a very modest, decrease in PC level in Chkb A mice, and this decrease is similar in both forelimb and hindlimb muscle.
  • the very small decrease in PC mass, and the fact that there is no rostral-to-caudal change in PC suggest a poor correlation of the anticipated biochemical defects and observed rostral-to-caudal phenotype of this muscular dystrophy.
  • a method of treatment of a subject in which fatty acid utilization is improved.
  • the method includes administering to the subject in need thereof therapeutically effective amounts of a peroxisome proliferator-activated receptor (Ppar) agonist and of choline, or pharmaceutically acceptable salts or prodrugs thereof.
  • Ppar peroxisome proliferator-activated receptor
  • Implementations may include one or more of the following.
  • the Ppar agonist is a fibrate.
  • the fibrate is ciprofibrate.
  • the fibrate is fenofibrate.
  • the fibrate is bezafibrate.
  • the fibrate is cardarine.
  • the choline is choline bitartrate.
  • the choline is supplied as a prodrug.
  • the prodrug is citicoline.
  • the prodrug is phospho-choline.
  • the subject is in need thereof because the subject suffers from a muscular dystrophy.
  • the subject suffers from a muscular dystrophy caused by loss of function of the CHKB gene.
  • the subject suffers from a myopathy caused by CPT2 deficiency.
  • the subject suffers from a myopathy or cardiomyopathy caused by loss of function of TAG lipase.
  • a pharmaceutical composition including a fibrate or pharmaceutically relevant salt or prodrug thereof (with the proviso that the salt is not choline), a choline or pharmaceutically relevant salt of prodrug thereof, and a pharmaceutically acceptable carrier or excipient.
  • FIG. 1 Choline kinase deficient mice display hallmark muscular dystrophy phenotypes. Legend is Chkb +/+ (green circle), Chkb +-/- (blue square), and Chkb -/- (purple triangle).
  • A Body weight was recorded each week at similar times over the entire duration of phenotyping experiment for Chkb +/+ , Chkb +-/- , and Chkb -/- mice.
  • B Grip strength measurements were performed at 3 different timepoints and normalized to body weight (BW).
  • C Total distance run during an exhaustion test for all experimental groups at 3 different timepoints.
  • E Loss in muscle force as a result of repeated contractions of EDL muscles by direct stimulation of the nerve for each genotype.
  • (F) Maximal specific force generated by freshly isolated extensor digitorum longus (EDL) muscle for each genotype All values are expressed as means ⁇ SEM; n 6-13 animals per group. Significance was calculated using one-way ANOVA with Tukey’s multiple comparison test for each specific time point. *P ⁇ 0.01 vs. all the other groups and #P ⁇ 0.05 vs. Chkb +/+ group at each specific timepoint.
  • Chkb +/+ , Chkb +-/- and Chkb -/- respectively labeled with green circles, blue squares, and purple triangles.
  • Figure 2 Chka protein expression is inversely correlated with the rostro-caudal gradient of severity in Chkb-mediated muscular dystrophy. Transmission electron microscopy (TEM) appearance of the (A) forelimb (triceps) and (B) hindlimb (quadriceps) of 115-day old Chkb -/- mice showing extensive injury in hindlimb not the forelimb.
  • TEM Transmission electron microscopy
  • FIG. 3 Loss of Chkb activity exerts a major effect on neutral lipid abundance. Comparison of expression levels of major glycerophospholipids and AcCa between the Chkb +/+ and Chkb -/- mice. The analysis was performed on (A-B), 12-day old hindlimb (quadriceps) and (C-D), 30 days old hindlimb (quadriceps) samples; A and C are respectively marked as green for Chkb +/+ and purple for Chkb -/- and presented as green (left side) / purple (right side) for each of the major glycerophospholipids and AcCa. (B and D) Summary of fold change and statistical tests performed on major glycerophospholipids.
  • n 3 mice per group. Pairwise Wilcoxon signed rank test with Bonferroni correction was used to determine the significance of a median pair wise fold-increase in lipid amounts at an overall significance level of 5%. As the Bonferroni correction is fairly conservative, significant differences are reported at both pre-correction (*) and post-correction (***) significance levels.
  • AcCa acylcarnitine
  • TG triacylglycerol
  • DG diacylglycerol
  • PC phosphatidylcholine
  • PE phosphatidylethanolamine
  • PG phosphatidylglycerol
  • PI phosphatidylinositol
  • PS phosphatidylserine.
  • E Transmission electron microscopy (TEM) appearance of the hindlimb muscle samples (quadriceps) of Chkb +/+ and Chkb -/- mice at 12 days and 115 days of age (representative of 3 mice per group).
  • LD Lipid droplets.
  • F Quadriceps muscle sections of 30 days old Chkb +/+ and Chkb -/- mice were fixed and stained with BODIPY-493/503 to visualize LDs (Green dot-like morphologies), which were seen throughout the Chkb -/- sections but not in the Chkb +/+ .
  • Concanavalin A dye conjugate (CFTM 633) and DAPI were used to stain membrane (Red) and nucleus (Blue) respectively (representative of 3 mice per group) and appear in both types of sections as web-like connections.
  • FIG. 1 Chkb regulates the gene expression of the members of the Ppar family as well as Ppar target genes.
  • A Relative gene expression of the Ppar family members.
  • B Western blot of hindlimb (quadriceps) samples from three distinct (lanes 1-3) Chkb +/+ , four distinct (lanes 4-7) Chkb +-/- and three distinct (lanes 8-10) Chkb -/- mice probed with anti-Ppara, anti- Pparb, anti-Pparg, anti-Cptlb and anti-Gapdh antibodies.
  • Fold-Change (2 L (- Delta Delta CT)) is the normalized gene expression (2 L (- Delta CT)) in the Chkb deficient hindlimb sample divided the normalized gene expression (2 L (- Delta CT)) in the control sample.
  • Fold-change values greater than one indicates a positive- or an up-regulation. Fold-change values less than one indicate a negative or down-regulation, and the fold-regulation is the negative inverse of the fold-change.
  • D The clustergram of the Ppar family, Rxr family and Ppar coactivators across three genotypes (shown as min/green, avg/black, max/red across a color continuum from green to red, per the legend).
  • FIG. 5 Chkb deficiency results in decreased fatty acid usage and increased lipid droplet accumulation in differentiated myocytes in culture.
  • A Representative image of isolated skeletal myoblasts from Chkb +/+ and Chkb -/- mice, cultured on Matrigel® coated culture flasks. At day 0, when the cells reached 80% confluency, the medium was replaced by differentiation medium and maintained in differentiation media for up to 8 days.
  • B Western blot of differentiated Chkb +/+ and Chkb -/- myocytes probed with anti-Chka, anti-Chkb, and anti-Gapdh antibodies.
  • OCRs oxygen consumption rates
  • Chkb +/+ and Chkb '-/- are respectively labeled with green circles and purple triangles. More specifically in F and H, green circles represent Palmitate-BSA Chkb +/+ while blue circles represent BSA Chkb +/+ (OCR values higher in green series); and purple triangles represent Palmitate-BSA Chkb '-/- while red triangles represent BSA Chkb '-/- (OCR values higher in purple series).
  • Isolated primary myocytes from Chkb +/+ and Chkb '-/- mice were fixed 5 days after differentiation and stained with BODIPY -493/503 to visualize LDs (Green). DAPI was used to stain nucleus (Blue).
  • FIG. 6 Ppar activation rescues defective fatty acid utilization and lipid droplet accumulation in differentiated Chkb '-/- myocytes in culture.
  • A Kinetic graph of the fatty acid oxidation of primary Chkb '-/- myocytes at day 7 of differentiation. The cells were treated with or without ciprofibrate (50 mM; squares), bezafibrate (500 mM; triangles) and fenofibrate (25 mM; inverted triangles) in the medium 72 hours prior to measurement.
  • B-C Quantification of basal respiration and maximal respiration which quantifies maximal electron transport activity induced by the chemical uncoupler FCCP. 6 technical replicates per group.
  • G To study the effect of Ppar agonist treatments on exogenous fatty acid utilization and storage, 4 days after differentiation, myocytes were treated with or without bezafibrate (500 mM) or GW501516 (2.5 mM) in the medium for 48 hours.
  • LDs dot-like morphologies
  • Figure 7 Increased intramyocellular lipid droplet accumulation in skeletal muscles from Chkb -/- mice.
  • A Comparison of expression levels of major glycerophospholipids and AcCa between the Chkb +/+ and Chkb -/- mice; 12 days old forelimb (triceps). Summary of fold change and statistical tests performed on major glycerophospholipids (B) as described in Figure 3.
  • FIG. 8 Protein expression of the members of the Ppar family in forelimb samples.
  • A Western blot of forelimb (triceps) samples from three distinct (lanes 1-3) Chkb +/+ , four distinct (lanes 4-7) Chkb +-/- and three distinct (lanes 8-10) Chkb -/- mice probed with anti-Ppara, anti- Pparb, anti-Pparg, anti-Cptlb and anti-Gapdh antibodies.
  • Chkb regulates the expression of the members of the Ppar family as well as Ppar target genes.
  • Clustergram showing non-supervised hierarchical clustering to display a heat map with dendrograms indicating co-regulated genes across groups or individual samples.
  • Sample dimension ID.
  • Join Type Average.
  • Color Coded Average Genes. Magnitude of gene expression is shown as min/green, avg/black, max/red across a color continuum from green to red, per the legend.
  • FIG. 10 Figure 10.
  • n 3 independent samples per group.
  • D-F RT-qPCR analysis of Chka gene expression in differentiated Chkb +/+ , Chkb -/- and Chkb -/- myocytes treated with or without Ciprofibrate 50 (mM) (G), GW501516 (2.5 mM) (H) or bezafibrate (500 mM) (I)
  • n 15 AcCa species from 3 independent samples for each group.
  • compositions and methods herein described relate to the discovery that progression of muscular dystrophy is driven by changes in fatty acid utilization and neutral lipid metabolism.
  • CHKB encodes one of two mammalian choline kinase enzymes that catalyze the first step in the synthesis of the major membrane phospholipid, phosphatidylcholine (PC).
  • PC major membrane phospholipid
  • inactivation of the CHKB gene causes a recessive form of a rostral-to-caudal congenital muscular dystrophy.
  • Chkb knockout mice we reveal that at no stage of the disease is PC level significantly altered. Instead, at early stages of the disease the level of mitochondrial specific lipids acylcarnitine (AcCa) and cardiolipin (CL) increase 15-fold and 10-fold, respectively, in affected muscle.
  • Chkb deficiency decreases the expression of peroxisome proliferator-activated receptors (Ppars) and target genes which reinforce the observed changes in lipid levels in Chkb -/- affected muscle.
  • Ppars peroxisome proliferator-activated receptors
  • Chkb deficient myocytes in culture have reduced capacity to utilize fatty acids for oxygen production, increased lipid droplet accumulation and enhanced markers of myocyte injury. Ppar activation rescues defective fatty acid utilization for mitochondrial respiration and lipid droplet accumulation in differentiated Chkb -/- myocytes.
  • Our findings indicate that the major change in lipid metabolism upon loss of function of Chkb is not a change in PC level, but instead is an initial inability to utilize fatty acids for energy resulting in shunting of fatty acids into triacyglycerol.
  • Ppar activation is a treatment option for muscular dystrophy and particularly in CHKB associated muscular dystrophy.
  • the addition of choline was found to further enhance the therapeutic effect.
  • AcCa level increase suggests there is either a decreased ability to transport of AcCa into mitochondria for subsequent fatty acid b-oxidation, and/or incomplete b-oxidation resulting in a backup of substrate within this pathway.
  • the expression of many of the enzymes required for fatty acid transport into mitochondria and subsequent fatty acid b-oxidation were decreased many fold in affected muscle of Chkb -/- mice.
  • the reduced fatty acid oxidation capacity is potentially being compensated by an increase in usage of other sources of fuel (Figure 5E-F).
  • the increase in AcCa level at the early stage of Chkb mediated muscular dystrophy, and the decreased expression of genes required for its synthesis and use, is consistent with an inability to import AcCa into mitochondria for fatty acid b-oxidation.
  • PC is imported into cells from serum via low density lipoproteins (LDL), and enhanced expression of scavenger receptor-Bl (SR-B1) and low-density lipoprotein receptor (LDLR) was previously observed in muscle of Chkb -/- mice, both of which would be expected to enhance the uptake of plasma PC 1 .
  • SR-B1 scavenger receptor-Bl
  • LDLR low-density lipoprotein receptor
  • An interesting mechanistic feature of disease progression in the Examples is the transition from an inability to synthesize PC in affected muscle to an increase in AcCa.
  • the synthesis of PC requires the consumption of diacylglycerol (DAG) at the final step in the CDP- choline pathway, and this would not occur in affected muscle as the choline kinase step is either inactivated ( Ckhb ) or downregulated (Chka).
  • DAG requires fatty acids for its synthesis, and an inability to synthesize DAG could result in an inability to utilize fatty acids for subsequent DAG synthesis. Indeed, over time we see an increase in DAG mass in affected muscle.
  • the inability to synthesize PC results in a metabolic defect downstream within this pathway that results in major changes in tangential yet connected lipid metabolic pathways over time, an inability to use excess fatty acid for energy followed by its storage as neutral lipid.
  • a method of treatment of a subject comprising administering to the subject in need thereof therapeutically effective amounts of a peroxisome proliferator-activated receptor (Ppar) agonist and of choline, or pharmaceutically acceptable salts or prodrugs thereof.
  • the Ppar agonist is a fibrate.
  • the fibrate is ciprofibrate.
  • the fibrate is fenofibrate.
  • the fibrate is bezafibrate.
  • the fibrate is cardarine.
  • the choline is choline bitartrate.
  • the choline is supplied as a prodrug, in which the prodrug is citicoline.
  • the choline is supplied as a prodrug, in which the prodrug is phospho-choline.
  • a pharmaceutical composition comprising a fibrate or pharmaceutically relevant salt or prodrug thereof (with the proviso that the salt is not choline), a choline or pharmaceutically relevant salt of prodrug thereof, and a pharmaceutically acceptable carrier or excipient.
  • compositions and methods are relevant to treatment of muscular dystrophies; particularly muscular dystrophy, congenital, megaconial type; and other diseases characterized by a CHKB deficiency.
  • compositions and methods are relevant to treatment of lipid storage myopathies, a group of genetic disorders characterized by excessive and pathological lipid accumulation in muscles and defined by progressive myopathy with muscle weakness, myalgia, and fatigue which are cause by dysfunction in intracellular neutral lipid metabolism and include the transport of carnitine, AcCa or long chain fatty acids, and defects in mitochondrial fatty acid b-oxidation.
  • compositions and methods are relevant to treatment of myopathy resulting from a decreased ability to metabolize AcCa due to CPT2 deficiency ( CPT2 , OMIM: #600650).
  • compositions and methods are relevant to treatment of myopathy or cardiomyopathy resulting from mutations in PNPLA2 (NLSD, OMIM: #275630), which encodes TAG lipase.
  • NLSD NLSD, OMIM: #275630
  • Many of the clinical presentations of NLSD including myopathy, cardiomyopathy, global developmental delay, mitochondrial defects, and premature death are also reported in patients with CHKB mutations.
  • acyl as used herein means an alkyl group, as defined herein, appended to the parent molecular moiety through a carbonyl group, as defined herein.
  • Representative examples of acyl include, but are not limited to, acetyl, 1-oxopropyl, 2, 2-dimethyl- 1-oxopropyl, 1- oxobutyl, and 1-oxopentyl.
  • administering should be understood to mean providing a compound of the present invention to an individual in a form that can be introduced into that individual’s body in an amount effective for prophylaxis, treatment, or diagnosis, as applicable.
  • forms may include e.g., oral dosage forms, injectable dosage forms, transdermal dosage forms, inhalation dosage forms, and rectal dosage forms.
  • hydroxy as used herein means an — OH group.
  • prodrug encompasses pharmaceutically acceptable esters, carbonates, thiocarbonates, N-acyl derivatives, N-acyloxyalkyl derivatives, quaternary derivatives of tertiary amines, N-Mannich bases, Schiff bases, aminoacid conjugates, phosphate esters, metal salts and sulfonate esters of compounds disclosed herein.
  • prodrugs include compounds that comprise a biohydrolyzable moiety (e.g., a biohydrolyzable amide, biohydrolyzable carbamate, biohydrolyzable carbonate, biohydrolyzable ester, biohydrolyzable phosphate, or biohydrolyzable ureide analog).
  • a biohydrolyzable moiety e.g., a biohydrolyzable amide, biohydrolyzable carbamate, biohydrolyzable carbonate, biohydrolyzable ester, biohydrolyzable phosphate, or biohydrolyzable ureide analog.
  • Prodrugs of compounds disclosed herein are readily envisioned and prepared by those of ordinary skill in the art. See, e.g., Design of Prodrugs, Bundgaard, A. Ed., Elsevier, 1985; Bundgaard, “Design and Application of Prodrugs,” A Textbook of Drug Design and Development, Krosgaard-Larsen
  • the compounds of the invention can be used in the form of pharmaceutically acceptable salts derived from inorganic or organic acids.
  • Pharmaceutically acceptable salt(s) are well- known in the art.
  • pharmaceutically acceptable salts generally refers to salts prepared from pharmaceutically acceptable non-toxic acids or bases including inorganic acids and bases and organic acids and bases.
  • Suitable pharmaceutically acceptable base addition salts include metallic salts made from aluminum, calcium, lithium, magnesium, potassium, sodium and zinc or organic salts made from lysine, N,N'- dibenzylethylenediamine, chloroprocaine, choline (excepting when an active ingredient is choline), diethanolamine, ethylenediamine, meglumine (N-methylglucamine) and procaine.
  • Suitable non-toxic acids include inorganic and organic acids such as acetic, alginic, anthranilic, benzenesulfonic, benzoic, camphorsulfonic, citric, ethenesulfonic, formic, fumaric, furoic, galacturonic, gluconic, glucuronic, glutamic, glycolic, hydrobromic, hydrochloric, isethionic, lactic, maleic, malic, mandelic, methanesulfonic, mucic, nitric, pamoic, pantothenic, phenylacetic, phosphoric, propionic, salicylic, stearic, succinic, sulfanilic, sulfuric, tartaric acid, and p-toluenesulfonic acid.
  • inorganic and organic acids such as acetic, alginic, anthranilic, benzenesulfonic, benzoic, camphorsulfonic, citric, ethe
  • Non-toxic acids include hydrochloric, hydrobromic, phosphoric, sulfuric, and methanesulfonic acids.
  • Examples of specific salts thus include hydrochloride and mesylate salts.
  • Others are well-known in the art. See, e.g., Remington's Pharmaceutical Sciences, 18 th ed. (Mack Publishing, Easton Pa.: 1990) and Remington: The Science and Practice of Pharmacy, 19 th ed. (Mack Publishing, Easton Pa.: 1995); these references are hereby incorporated by reference in their entireties.
  • acid addition salts, carboxylate salts, amino acid addition salts, and zwitterion salts of compounds of the present invention may also be considered pharmaceutically acceptable if they are, within the scope of sound medical judgment, suitable for use in contact with the tissues of humans and lower animals without undue toxicity, irritation, allergic response, and the like, are commensurate with a reasonable benefit/risk ratio, and are effective for their intended use.
  • Such salts may also include various solvates and hydrates of the compound of the present invention.
  • pharmaceutically acceptable excipient means a non-toxic, inert solid, semi-solid or liquid filler, diluent, encapsulating material or formulation auxiliary of any type.
  • materials which can serve as pharmaceutically acceptable carriers are sugars such as lactose, glucose and sucrose; starches such as com starch and potato starch; cellulose and its derivatives such as sodium carboxymethyl cellulose, ethyl cellulose and cellulose acetate; powdered tragacanth; malt; gelatin; talc; cocoa butter and suppository waxes; oils such as peanut oil, cottonseed oil, safflower oil, sesame oil, olive oil, corn oil and soybean oil; glycols; such a propylene glycol; esters such as ethyl oleate and ethyl laurate; agar; buffering agents such as magnesium hydroxide and aluminum hydroxide; alginic acid; pyrogen
  • the terms “prevent,” “preventing” and “prevention” contemplate an action that occurs before a patient begins to suffer from the specified disease or disorder, which inhibits or reduces the severity of the disease or disorder or of one or more of its symptoms.
  • the terms encompass prophylaxis.
  • a “prophylactically effective amount” of a compound is an amount sufficient to prevent a disease or condition, or one or more symptoms associated with the disease or condition, or prevent its recurrence.
  • a prophylactically effective amount of a compound is an amount of therapeutic agent, alone or in combination with other agents, which provides a prophylactic benefit in the prevention of the disease.
  • the term “prophylactically effective amount” can encompass an amount that improves overall prophylaxis or enhances the prophylactic efficacy of another prophylactic agent.
  • a “therapeutically effective amount” of a compound is an amount sufficient to treat a disease or condition, or one or more symptoms associated with the disease or condition.
  • “Therapeutically effective amounts” of two or more compounds may be optimized by varying the administered amount of one compound in the presence of a constant amount of the other.
  • a therapeutically effective amount of a Ppar agonist by itself is established, and the amount of choline administered is titrated based on patient response to arrive at the therapeutically effective amount of choline.
  • both the Ppar agonist and choline amounts are varied to arrive at the preferred therapeutically effective amounts.
  • subject is intended to include living organisms in which disease may occur. Examples of subjects include humans, monkeys, cows, sheep, goats, dogs, cats, mice, rats, and transgenic species thereof.
  • substantially pure means that the isolated material is at least 90% pure, preferably 95% pure, even more preferably 99% pure as assayed by analytical techniques known in the art.
  • compositions of the present invention can be formulated for oral administration in solid or liquid form, for parenteral intravenous, subcutaneous, intramuscular, intraperitoneal, intra arterial, or intradermal injection, for or for vaginal, nasal, topical, or rectal administration.
  • Pharmaceutical compositions of the present invention suitable for oral administration can be presented as discrete dosage forms, e.g., tablets, chewable tablets, caplets, capsules, liquids, and flavored syrups. Such dosage forms contain predetermined amounts of active ingredients, and may be prepared by methods of pharmacy well known to those skilled in the art. See generally, Remington's Pharmaceutical Sciences, 18th ed., Mack Publishing, Easton Pa. (1990); hereby incorporated by reference in its entirety.
  • Parenteral dosage forms can be administered to patients by various routes including subcutaneous, intravenous (including bolus injection), intramuscular, and intraarterial. Because their administration typically bypasses patients' natural defenses against contaminants, parenteral dosage forms are specifically sterile or capable of being sterilized prior to administration to a patient. Examples of parenteral dosage forms include solutions ready for injection, dry products ready to be dissolved or suspended in a pharmaceutically acceptable vehicle for injection, suspensions ready for injection, and emulsions. Pharmaceutical compositions for parenteral injection comprise pharmaceutically acceptable sterile aqueous or nonaqueous solutions, dispersions, suspensions or emulsions and sterile powders for reconstitution into sterile injectable solutions or dispersions.
  • aqueous and nonaqueous carriers, diluents, solvents or vehicles examples include water, ethanol, polyols (propylene glycol, polyethylene glycol, glycerol, and the like, and suitable mixtures thereof), vegetable oils (such as olive oil) and injectable organic esters such as ethyl oleate, or suitable mixtures thereof.
  • Suitable fluidity of the composition may be maintained, for example, by the use of a coating such as lecithin, by the maintenance of the required particle size in the case of dispersions, and by the use of surfactants.
  • These compositions may also contain adjuvants such as preservative agents, wetting agents, emulsifying agents, and dispersing agents.
  • microorganisms Prevention of the action of microorganisms may be ensured by various antibacterial and antifungal agents, for example, parabens, chlorobutanol, phenol, sorbic acid, and the like. It may also be desirable to include isotonic agents, for example, sugars, sodium chloride and the like. Prolonged absorption of the injectable pharmaceutical form may be brought about by the use of agents delaying absorption, for example, aluminum monostearate and gelatin.
  • agents delaying absorption for example, aluminum monostearate and gelatin.
  • Suspensions in addition to the active compounds, may contain suspending agents, for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, tragacanth, and mixtures thereof.
  • suspending agents for example, ethoxylated isostearyl alcohols, polyoxyethylene sorbitol and sorbitan esters, microcrystalline cellulose, aluminum metahydroxide, bentonite, agar-agar, tragacanth, and mixtures thereof.
  • the compounds of the invention can be incorporated into slow-release or targeted-delivery systems such as polymer matrices, liposomes, and microspheres. They may be sterilized, for example, by filtration through a bacteria-retaining filter or by incorporation of sterilizing agents in the form of sterile solid compositions, which may be dissolved in sterile water or some other sterile injectable medium
  • Injectable depot forms are made by forming microencapsulated matrices of the drug in biodegradable polymers such as polylactide-polyglycolide. Depending upon the ratio of drug to polymer and the nature of the particular polymer employed, the rate of drug release can be controlled. Examples of other biodegradable polymers include poly(orthoesters) and poly(anhydrides). Depot injectable formulations also are prepared by entrapping the drug in liposomes or microemulsions which are compatible with body tissues.
  • biodegradable polymers such as polylactide-polyglycolide.
  • Depot injectable formulations also are prepared by entrapping the drug in liposomes or microemulsions which are compatible with body tissues.
  • the injectable formulations can be sterilized, for example, by filtration through a bacterial-retaining filter or by incorporating sterilizing agents in the form of sterile solid compositions which can be dissolved or dispersed in sterile water or other sterile injectable medium just prior to use.
  • Injectable preparations for example, sterile injectable aqueous or oleaginous suspensions may be formulated according to the known art using suitable dispersing or wetting agents and suspending agents.
  • the sterile injectable preparation may also be a sterile injectable solution, suspension or emulsion in a nontoxic, parenterally acceptable diluent or solvent such as a solution in 1,3-butanediol.
  • acceptable vehicles and solvents that may be employed are water, Ringer's solution, U.S.P. and isotonic sodium chloride solution.
  • sterile, fixed oils are conventionally employed as a solvent or suspending medium.
  • any bland fixed oil can be employed including synthetic mono- or diglycerides.
  • fatty acids such as oleic acid are used in the preparation of injectables.
  • Solid dosage forms for oral administration include capsules, tablets, pills, powders, and granules.
  • one or more compounds of the invention is mixed with at least one inert pharmaceutically acceptable carrier such as sodium citrate or dicalcium phosphate and/or a) fillers or extenders such as starches, lactose, sucrose, glucose, mannitol, and salicylic acid; b) binders such as carboxymethylcellulose, alginates, gelatin, polyvinylpyrrolidinone, sucrose, and acacia; c) humectants such as glycerol; d) disintegrating agents such as agar-agar, calcium carbonate, potato or tapioca starch, alginic acid, certain silicates, and sodium carbonate; e) solution retarding agents such as paraffin; f) absorption accelerators such as quaternary ammonium compounds; g) wetting agents such as cetyl alcohol and glycerol monostearate
  • Solid compositions of a similar type may also be employed as fillers in soft and hard- filled gelatin capsules using lactose or milk sugar as well as high molecular weight polyethylene glycols.
  • the solid dosage forms of tablets, dragees, capsules, pills, and granules can be prepared with coatings and shells such as enteric coatings and other coatings well known in the pharmaceutical formulating art. They may optionally contain opacifying agents and can also be of a composition that they release the active ingredient(s) only, or preferentially, in a certain part of the intestinal tract in a delayed manner. Examples of materials which can be useful for delaying release of the active agent can include polymeric substances and waxes.
  • Liquid dosage forms for oral administration include pharmaceutically acceptable emulsions, microemulsions, solutions, suspensions, syrups and elixirs.
  • the liquid dosage forms may contain inert diluents commonly used in the art such as, for example, water or other solvents, solubilizing agents and emulsifiers such as ethyl alcohol, isopropyl alcohol, ethyl carbonate, ethyl acetate, benzyl alcohol, benzyl benzoate, propylene glycol, 1,3-butylene glycol, dimethylformamide, oils (in particular, cottonseed, groundnut, com, germ, olive, castor, and sesame oils), glycerol, tetrahydrofurfuryl alcohol, polyethylene glycols and fatty acid esters of sorbitan, and mixtures thereof.
  • inert diluents commonly used in the art such as, for example, water or other solvents, solubilizing agents and
  • the oral compositions can also include adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, and perfuming agents.
  • adjuvants such as wetting agents, emulsifying and suspending agents, sweetening, flavoring, and perfuming agents.
  • Dosage forms for topical or transdermal administration of a compound of this invention include ointments, pastes, creams, lotions, gels, powders, solutions, sprays, inhalants or patches.
  • a desired compound of the invention is admixed under sterile conditions with a pharmaceutically acceptable carrier and any needed preservatives or buffers as may be required. Ophthalmic formulation, ear drops, eye ointments, powders and solutions are also contemplated as being within the scope of this invention.
  • the ointments, pastes, creams and gels may contain, in addition to an active compound of this invention, animal and vegetable fats, oils, waxes, paraffins, starch, tragacanth, cellulose derivatives, polyethylene glycols, silicones, bentonites, silicic acid, talc and zinc oxide, or mixtures thereof.
  • Powders and sprays can contain, in addition to the compounds of this invention, lactose, talc, silicic acid, aluminum hydroxide, calcium silicates and polyamide powder, or mixtures of these substances.
  • Sprays can additionally contain customary propellants such as chlorofluorohydrocarbons.
  • Liposomes are generally derived from phospholipids or other lipid substances. Liposomes are formed by mono- or multi-lamellar hydrated liquid crystals that are dispersed in an aqueous medium. Any non-toxic, physiologically acceptable and metabolizable lipid capable of forming liposomes may be used.
  • the present compositions in liposome form may contain, in addition to the compounds of the invention, stabilizers, preservatives, and the like.
  • the preferred lipid components for liposomal delivery are the natural and synthetic phospholipids and phosphatidylcholines (lecithins) used separately or together.
  • compositions of this invention can be varied so as to obtain an amount of the active compound(s) that is effective to achieve the desired therapeutic response for a particular patient, compositions and mode of administration.
  • the selected dosage level will depend upon the activity of the particular compound, the route of administration, the severity of the condition being treated and the condition and prior medical history of the patient being treated. However, it is within the skill of the art to start doses of the compound at levels lower than required to achieve the desired therapeutic effect and to gradually increase the dosage until the desired effect is achieved.
  • an effective amount of one of the compounds of the invention can be employed in pure form or, where such forms exist, in pharmaceutically acceptable salt form.
  • the compound can be administered as a pharmaceutical composition containing the compound of interest in combination with one or more pharmaceutically acceptable carriers. It will be understood, however, that the total daily usage of the compounds and compositions of the invention will be decided by the attending physician within the scope of sound medical judgment.
  • the specific effective dose level for any particular patient will depend upon a variety of factors including the disorder being treated and the severity of the disorder; activity of the specific compound employed; the specific composition employed; the age, body weight, general health, sex and diet of the patient; the time of administration, route of administration, and rate of excretion of the specific compound employed; the duration of the treatment; the risk/benefit ratio; drugs used in combination or coincidental with the specific compound employed; and like factors well known in the medical arts. For example, it is well within the skill of the art to start doses of the compound at levels lower than required to achieve the desired therapeutic effect and to gradually increase the dosage until the desired effect is achieved.
  • the total daily dose of Ppar agonist as administered to a human or lower animal may range from about 0.0003 to about 30 mg/kg of body weight.
  • more preferable doses can be in the range of from about 0.0003 to about 1 mg/kg body weight.
  • the effective daily dose can be divided into multiple doses for purposes of administration; consequently, single dose compositions may contain such amounts or submultiples thereof to make up the daily dose.
  • the compositions of the invention are preferably provided in the form of tablets or capsules containing about 1.0, about 5.0, about 10.0, about 15.0, about 25.0, about 50.0, about 100, about 250, or about 500 milligrams of the Ppar agonist.
  • Established tolerable upper intake levels for choline from food and supplementation in healthy individuals ranges from 1,000 mg/day in individuals aged 1-3 to 3,500 mg/day in individuals aged 19 or older.
  • the total daily dose of choline as administered to a human or lower animal may range from about 25 mg/day to about 7,000 mg/day.
  • more preferable doses can be in the range of from about 250 mg/day to about 3,500 mg/day; however, for diseased subjects under a physician’s supervision, doses can exceed 3,500 mg/day.
  • the effective daily dose can be divided into multiple doses for purposes of administration; consequently, single dose compositions may contain such amounts or submultiples thereof to make up the daily dose.
  • compositions of the invention are preferably provided in the form of tablets or capsules containing about 1.0, about 5.0, about 10.0, about 15.0, about 25.0, about 50.0, about 100, about 250, or about 500 milligrams of choline.
  • administration of choline comprises administration by use of pharmaceutically relevant salts such as choline bitartrate.
  • administration of choline comprises administration by use of a prodrug such as citicoline.
  • administration of choline supplementation is adjusted for expected or measured levels of dietary choline.
  • the Ppar agonist and choline are both present in the same tablet or capsule for ease of administration.
  • Example 1 Choline kinase deficient mice display hallmark muscular dystrophy phenotypes
  • mice heterozygous for Chkb gene display similar phenotypes to wild type mice.
  • mice lacking both copies of the Chkb gene display a significant decrease in overt neuromuscular phenotypes.
  • CK creatinine kinase
  • Chkb -/- mice displayed a specific EDL force that was 10% that of Chkb +/+ or Chkb +-/- mice.
  • Chkb -/- mice were at maximally fatigued levels, that is those observed in Chkb +/+ or Chkb +-/- mice after 60 muscle stimulations, at the first stimulation.
  • Hindlimb muscle from Chkb -/- mice produce less force, and are much more easily fatigued, than that of wild type or Chkb heterozygous mice.
  • mice with one functional copy of the CHKB gene do not possess any obvious overt muscle dysfunction, whereas mice that are homozygous null for functional copies of the Chkb gene display hallmark muscular dystrophy phenotypes.
  • Example 2 - Chka protein expression is inversely correlated with the rostro-caudal gradient of severity in Chkb-mediated muscular dystrophy
  • Chkb encodes choline kinase b, the first enzymatic step in the synthesis of PC, the most abundant phospholipid present in eukaryotic membranes.
  • a second choline kinase, Chka is present in mouse (and human) tissues.
  • Chkb +-/- mice there was a -50% decrease in Chkb protein detected in both the forelimb and hindlimb muscles of Chkb +/- mice compared to wild type ( Figure 2C-D). There was no change in Chka protein level in hindlimb muscle of Chkb +/- mice compared to wild type, and a small but statistically insignificant increase in Chka level in forelimb muscle.
  • Chkb protein expression was undetectable consistent with the allele not producing Chkb protein.
  • forelimb muscle from Chkb -/- mice there was a compensatory upregulation of Chka protein expression to almost 3-fold that observed in wild type mice.
  • hindlimb muscle from Chkb -/- mice Chka protein expression was decreased to less than 10% that observed in wild type mice.
  • a compensatory level of Chka protein expression inversely correlates with the rostro-caudal gradient of severity in Chkb -/- associated muscular dystrophy.
  • Example 3 Loss of Chkb activity exerts a major effect on neutral lipid abundance
  • PC synthesis is integrated with the synthesis of other major phospholipid classes, as well as AcCa, fatty acids and the neutral lipids diacylglycerol and triacylglycerol.
  • Lipidomics was used to determine if complete loss of Chkb function, and the associated upregulation of Chka in the forelimb but not hindlimb muscle of Chkb -/- mice, differentially altered lipid metabolism.
  • the levels of the major glycerophospholipids, neutral lipids and acylcamitine in hindlimb and forelimb muscle isolated from 12-day old and 30-day old Chkb +/+ and Chkb -/- mice were quantified.
  • Phosphatidylethanolamine (PE) and phosphatidylinositol (PI) levels were also slightly increased (-1.5 fold) in both forelimb and hindlimb muscles of 12-day old Chkb -/- mice.
  • the large changes in lipid levels in hindlimb muscle, versus forelimb, of Chkb -/- mice are consistent with the rostral-to-caudal nature of the muscular dystrophy observed in these mice.
  • Ppara and Pparb/d primarily regulate the expression of genes required for fatty acid oxidation, with Pparb/d also regulating genes required for mitochondria biogenesis.
  • Pparg is primarily expressed in adipose tissue and regulates insulin sensitivity and glucose metabolism.
  • RT reverse transcription
  • qPCR quantitative polymerase chain reaction
  • Rxra There are three members of the Rxr family, Rxra, Rxrb, and Rxrg, and their expression was reduced 8-, 5-, and 16-fold in hindlimb muscle of Chkb -/- mice compared to wild type ( Figure 4C and D).
  • Ppar and Rxr heterodimers are bound to DNA with coactivator molecules 27 and the expression of each co-activator was also decreased from 2.8- to 14.4-fold compared to wild type ( Figure 4C and D).
  • Carnitine palmitoyltransferase lb (Cptlb), the major muscle isoform of Cpt, is involved in the carnitine shuttle as it catalyzes the conversion of cytoplasmic long-chain fatty acyl-CoA and carnitine into AcCa that are translocated across the inner mitochondrial membrane for subsequent mitochondrial fatty acid b-oxidation.
  • the expression of Cptlb was decreased 7.9-fold in affected muscle of Chkb -/- mice.
  • Ppara and Ppar b/d are the major transcriptional reporters that regulate expression of fatty acid metabolizing genes.
  • the many-fold decrease in the expression of these Ppars that was specific to affected muscle, along with their coreceptors and downstream target genes corroborate the lipdomics data that show a major change in lipid metabolism in muscular dystrophy (particularly Chkb mediated) is an inability to metabolize fatty acids via mitochondrial b-oxidation resulting in shunting of excess fatty acid into TG rich lipid droplets.
  • Example 5 Chkb deficiency results in decreased fatty acid oxidation and increased lipid droplet accumulation in differentiated myocytes in culture
  • Chkb +/+ and Chkb -/- cells There was no difference between the Chkb +/+ and Chkb -/- cells in terms of the percentage of nuclei within the myotubes, the average number of nuclei in each myotube, or the distribution of nuclei in myotubes (Figure 5D). Loss of Chkb function does not appear to affect gross myoblast differentiation.
  • Chkb -/ -yocytes have reduced fatty acid oxidation capacity by initially normalizing fat oxidation capacity to other sources of fuel, and that mitochondrial respiration in primary Chkb -/- ym ocytes progressively declines.
  • the increase in TG level in differentiated muscle cells isolated from Chkb - / - mice is in line with the increased TG and lipid droplet levels observed in isolated hindlimb muscle from older Chkb -/- mice and shows that the increase in TG in hindlimb muscle due to the loss of Chkb function is a direct effect on lipid metabolism within the muscle cells themselves.
  • Example 6 - Ppar activation via fibrate administration rescues defective fatty acid utilization and lipid droplet accumulation in differentiated Chkb -/- myocytes in culture
  • Example 6 - Ppar activation via fibrate administration rescues defective fatty acid utilization and lipid droplet accumulation in differentiated Chkb -/- myocytes in culture
  • a Ppar signaling pathway(s) we treated Chkb -/- myocytes with the Ppara agonists ciprofibrate and fenofibrate, the pan Ppar agonist bezafibrate, and the Pparb/d specific agonist cardarine (also known as GW 501516) and assessed the capacity of the myocytes to oxidize fatty acid.
  • LDs were noticeably more abundant and larger in Chkb -/- myocytes compared to the wild type, however, Ppar activation by bezafibrate or cardarine significantly decreased lipid droplets in Chkb deficient myotubes to a level comparable to wild type.
  • Ppar activation by bezafibrate or cardarine significantly decreased lipid droplets in Chkb deficient myotubes to a level comparable to wild type.
  • One interesting observation was the increased clusters of colocalized LDs and mitochondria in Chkb -/- myocytes treated with cardarine (Figure 6G).
  • ciprofibrate, bezafibrate or cardarine treatment of Chkb -/- myocytes for 48 hours resulted in a 2-to-4-fold increase in Chka gene expression and a significant reduction in the marker of myocyte injury ( Icaml ) ( Figure 6H and I).
  • Chkb mutant mice in C57BL/6J background were originally generated at the Jackson Laboratory (Bar Harbor, Maine, USA). Male Chkb +-/- mice on the C57BL/6J background were crossed with female Chkb +-/- on the same background to generate Chkb +/+ , Chkb -/- and Chkb +-/- littermates.
  • the mutation identified in Chkb -/- mice is a 1.6 kb genomic deletion between exon 3 and intron 9 that results in expression of a truncated mRNA and the absence of Chkb protein expression.
  • Mouse genotyping The mutation identified in Chkb -/- mice is a 1.6 kb genomic deletion between exon 3 and intron 9.
  • AccuStart II Mouse Genotyping Kit (Beverly, MA, USA) was used 11 extract DNA from ear punches and to perform PCR analysis.
  • a single genotyping program was used to amplify both the wild type Chkb allele between exons 5 and 9 and the truncated Chkb allele between exons 2 and 10.
  • the primers used for genotyping were purchased from Integrated DNA Technologies (Coralville, IA, USA).
  • the primer sequences to genotype wild type are Forward Primer: 5'-GTG GGT GGC ACT GGC ATT TAT -3'; Reverse Primer: 5'- GTT TCT TCT GTT CCT CTT CGG AGA-3' (amplicon size 753 bp).
  • the primer sequences to genotype the mutants are: Forward Primer: 5'-TAC CCA CGT ACC TCT GGC TTT T -3' Reverse Primer: 5'-GCT TTC CTG GAG GAC GTG AC 3'(amplicon size 486 bp).
  • the exhaustion test was performed at 3 time points (7, 13, 19 weeks old) in each group. Groups of mice were made to run on a horizontal treadmill for 5 min at 5 m/min, followed by an increase in the speed of lm/min each minute. The total distance run by each mouse until exhaustion was measured. Exhaustion was defined as the inability of the mouse to continue running on the treadmill for 30 seconds, despite repeated gentle stimulation.
  • mice were deeply anesthetized with ketamine and xylazine (80 and 10 mg/kg).
  • the extensor digitorum longus (EDU) muscle of the right hindlimb was removed for comparison of Ex vivo force contractions between groups as previously described.
  • the EDU muscle was securely tied with braided surgical silk at both tendon insertions to the lever arm of a servomotor/force transducer (model 305B) (Aurora Scientific, Aurora, Ontario, Canada) and the proximal tendon was fixed to a stationary post in a bath containing buffered Ringer solution (composition in mM: 137 NaCl, 24 NaHCO 3 , 11 glucose, 5 KC1, 2 CaC1 2 , 1MgO 4 , 1 NaH 2 P0 4 and 0.025 turbocurarine chloride) maintained at 25°C and bubbled with 95% 0 2 - 5% CO2 to stabilize pH at 7.4.
  • buffered Ringer solution composition in mM: 137 NaCl, 24 NaHCO 3 , 11 glucose, 5 KC1, 2 CaC1 2 , 1MgO 4 , 1 NaH 2 P0 4 and 0.025 turbocurarine chloride
  • the maximal force developed was measured during trains of stimulation (300 milliseconds, ms) with increasing frequencies up to 250 Hz or until the highest plateau was achieved. The force generated to obtain the highest plateau was used to determine specific force (maximal force normalized to cross-sectional area of the muscle).
  • the muscle was subjected to a fatigue protocol consisting of 60 isometric contractions for 300 ms each, once every 5 seconds. The frequency at which the EDL muscles were stimulated is 250 Hz. The force was recorded every 10th contraction during the repetitive contractions and again at 5 and 10 min afterward to measure recovery.
  • Creatine kinase (CK) serum levels - CK was determined from serum taken from blood samples withdrawn by cheek bleed at 3 time points (5, 10 and 15 weeks old). Blood was centrifuged for 3000 g for 10 min at 4°C to obtain the serum. CK determination was performed by standard spectrophotometric analysis, using a CK diagnostic kit (Cat. no. C7522-450,
  • RNA isolation, cDNA generation, and RT qPCR - Isolated tissue samples were incubated overnight in pre-chilled RNAlater® (Cat. no. R0901, Sigma- Aldrich, Ontario, Canada) at 4°C. Tissues were then homogenized in TRIzol reagent (Cat. no. 15596026, Invitrogen, MA, USA) and total RNA was isolated according to the manufacturer’s protocol. Nine hundred nanograms of total RNA was reverse transcribed using High-Capacity cDNA Reverse Transcription Kit (Cat. no. 4368814, Applied Biosystems, MA, USA).
  • Quantitative real-time RT-PCR assays were performed on the Bio-Rad CFX96 Touch Real-Time PCR Detection (Bio- Rad, California, USA) System using TaqMan Fast Advanced Master Mix (Cat. no. 4444557) and TaqMan Gene Expression Assays (Cat. no.
  • RNA quality was determined using a spectrophotometer and was reverse transcribed using a cDNA conversion kit.
  • the cDNA was used on the real-time RT2 Profiler PCR Array (QIAGEN, Cat. no. PAMM-149Z) in combination with RT2 SYBR® Green qPCR Mastermix (Cat. no. 330529).
  • CT values were exported to an Excel file to create a table of CT values. This table was then uploaded on to the data analysis web portal at http://www.qiagen.com/geneglobe. Samples were assigned to controls and test groups.
  • CT values were normalized based on a manual selection of reference genes.
  • the data analysis web portal calculates fold change/regulation using delta-delta CT method, in which delta CT is calculated between gene of interest (GOI) and an average of reference genes (HKG), followed by delta-delta CT calculations (delta CT (Test Group)-delta CT (Control Group)). Fold Change is then calculated using 2 L (-delta delta CT) formula.
  • the data analysis web portal was used to plot scatter clustergram and heat map.
  • C30-RPLC separation was carried out at 30°C (column oven temperature) with a flow rate of 0.2 mL/min, and 10 pL of the lipid extraction suspended in the mobile phase solvents mixtures (A:B, 70:30%) was injected onto the column.
  • the following system gradient was used for separating the lipid classes and molecular species: 30% solvent B for 3 min; then solvent B increased to 50% over 6 min, then to 70% B in 6 min, then kept at 99% B for 20 min, and finally the column was re-equilibrated to starting conditions (30% solvent A) for 5 min prior to each new injection.
  • the instrument was externally calibrated to 1 ppm using ESI negative and positive calibration solutions (ThermoScientific, MO, USA). Tune parameters were optimized using a mixture of lipid standards (Avanti Polar Lipids, Alabama, USA) in both negative and positive ion mode Thermo ScientificTM LipidSearchTM software version 4.2 was used for lipid identification and quantitation.
  • the individual data files were searched for product ion MS/MS spectra of lipid precursor ions. MS/MS fragment ions were predicted for all precursor adduct ions measured within ⁇ 5 ppm. The product ions that matched the predicted fragment ions within a ⁇ 5 ppm mass tolerance was used to calculate a match-score, and those candidates providing the highest quality match were determined.
  • the search results from the individual positive or negative ion files from each sample group were aligned within a retention time window ( ⁇ 0.2 min) and the data were merged for each annotated lipid.
  • the individual concentrations were then gathered together by lipid identity (summing together the concentration of multiple mass spectrometry adducts where these adducts originated from the same molecular source and averaging together biological replicates) and grouped within the broader categories of AcCa, TG, DG, PC, PE, PG, CL, PI, PS.
  • the result was nine groups containing multiple lipid concentrations corresponding to specific lipid identities, which were then compared between wild type and KO samples using a (paired, non-parametric) Wilcoxon signed-rank test at an overall significance level of 5%
  • Nile red 550 / 640 nm, BODIPY 493/503 nm and nuclei staining of muscle tissue - Quadriceps and gastrocnemius muscles were embedded in Optimal Cutting Temperature (Sakura Finetek, Torrence, CA), and were frozen in cooled isopentane in liquid nitrogen and stored at - 80°C. Frozen sections (7 pm thick) were thaw-mounted on SuperFrost Microscope slides (Microm International, Kalamazoo, MI) and air dried.
  • Tissue sections were then fixed in 4% (w/v) paraformaldehyde for 15 minutes and incubated with Concanavalin A CF Dye Conjugates CF633 (50-200 pg/mL) for 20 minutes followed by incubation with either Nile red solution in PBS (0.5 pg/mL) or BODIPY 493/503 for 15 minutes.
  • the sections were then washed for 5 times with PBS, each time for 15 minutes and mounted using ProLong Gold Antifade Mountant with DAPI (Thermo ScientificTM, Cat. no. P36931) and cured overnight in the dark.
  • mice were euthanized via CO2, were sprayed with 70% ethanol and transferred to a sterile hood.
  • the forelimb and hindlimb muscles were removed, finely minced into small pieces and transferred to a 50 ml conical tube.
  • 1 ml enzymatic solution of PBS containing collagenase type II (500 U/mL), collagenase D (1.5 U/mL), dispase II (2.5 U/mL), and CaCh (2.5 mM) was added to the tube.
  • the muscle mixture was placed in a water bath at 37°C for 60 minutes with agitation every 5 minutes.
  • the suspension was centrifuged for 10 minutes at 300 g. Following centrifugation, the supernatant was removed and discarded, and the pellet was resuspended in proliferation medium.
  • Proliferation medium included high glucose Dulbecco's Modified Eagle Medium (DMEM,
  • the re-suspended pellet containing small pieces of muscle tissue was plated on Matrigel coated flasks at 10-20% surface coverage and incubated at 37°C and 5% CO2 to allow attachment of the tissues to the surface and subsequent outgrowth and migration of cells.
  • the myogenic cell population was further purified with one round of pre plating on collagen coated dishes to isolate fibroblasts from myoblasts. To induce differentiation into multinucleated myotubes, the cells were seeded at 10000 cells/cm 2 on plastic coverslip chambers coated with Matrigel and the medium was replaced by differentiation medium containing DMEM with high glucose and 5% HS.
  • Isolated skeletal myoblasts were cultured on Matrigel coated glass chamber slides (Thermo Scientific, Cat. no. 154534) and differentiated into myocyte. 3 days after differentiation, the cells were washed two times with PBS and fixed in 4% (w/v) paraformaldehyde for 15 minutes. The cells were washed with PBS for 10 minutes and incubated with BODIPY solution in PBS for 15 minutes, at room temperature on a shaker. The cells were then washed for 3 times with PBS, each time for 15 minutes and mounted using ProLong Gold Antifade Mountant with DAPI (Thermo Scientific, Cat. no. P36931) and cured overnight in the dark.
  • DAPI ProLong Gold Antifade Mountant with DAPI
  • the cells were treated with or without ciprofibrate (50 mM), bezafibrate (500 mM) and fenofibrate (25 mM) in the medium 72 h prior to measurement.
  • ciprofibrate 50 mM
  • bezafibrate 500 mM
  • fenofibrate 25 mM
  • calibration sensors were prepared according to the manufacturer’s instructions.
  • differentiation medium was exchanged for DMEM base medium (Agilent, Cat. no. 103575-100) supplemented with 1 mM pyruvate, 2 mM glutamine, and 10 mM glucose and the plates were equilibrated at 37°C for 1 h before the measurements.
  • mitochondrial function was probed by the sequential addition of oligomycin (1 mM), FCCP (carbonyl cyanide- p-trifluoromethoxyphenylhydrazone; 4 mM), rotenone (1 mM) and antimycin A (5 mM); all final concentrations. Three measurements were performed for each condition. All experiments were normalized to total protein as determined by a bicinchoninic acid (BCA) protein quantitation assay.
  • BCA bicinchoninic acid
  • the mitochondrial content was determined from the images at 10,000x magnification using Image J software and calculated as mitochondria count/field by blinded investigators. Point counting was used to estimate mitochondrial volume density and mitochondrial cristae density based on standard stereological methods. Only mitochondria profiles of acceptable quality defined as clear visibility and no or few missing spots of the inner membrane were included. Using ImageJ software, a point grid was digitally layered over the micrographic images at 20,000x or 40,000x magnification for mitochondrial volume density and cristae density calculations respectively. Grid sizes of 85 nm x 85 nm and 165 nm x 165 nm were used to estimate mitochondria volume and cristae surface area, respectively.
  • Mitochondria volume density was calculated by dividing the points assigned to mitochondria to the total number of points counted inside the muscle.
  • Proteins were separated by SDS-PAGE and transferred to nitrocellulose membranes. The membranes were incubated in Odyssey blocking solution for 1 h. Total proteins were detected by probing the membranes with appropriate primary antibodies overnight at 4°C. The following antibodies were used: Chka (1:1000, Abeam Cat#ab88053), Ppara (1:1000, Abeam, Cat#Ab24509), Pparb (1:1000, Biorad, Cat#AHP1272), Cptlb (1:1000,

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Abstract

Sont divulguées, entre autres, des compositions et des méthodes de traitement de la dystrophie musculaire et d'autres maladies. Est divulguée, une méthode de traitement d'un sujet, dans laquelle l'utilisation d'acide gras est améliorée. La méthode consiste à administrer au sujet en ayant besoin des quantités thérapeutiquement efficaces d'un agoniste du récepteur activé par les proliférateurs des peroxysomes (Ppar) et de choline, ou de sels ou promédicaments pharmaceutiquement acceptables de ces derniers. L'invention concerne également des compositions comprenant un agoniste de Ppar et de la choline.
PCT/CA2022/050283 2021-03-03 2022-02-28 Composés et traitements de la dystrophie musculaire WO2022183281A1 (fr)

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CA2719811A1 (fr) * 2008-03-28 2009-10-01 Elan Pharma International Ltd. Formes galeniques de fenofibrate
US20130197043A1 (en) * 2010-08-31 2013-08-01 Snu R&Db Foundation Use of the fetal reprogramming of a ppar agonist

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