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PHARMACOLOGICAL PROPERTIES OF N-(3,5-DIAMINO-6-CHLOROPYRAZINE- 2-CARBONYL)-N’-4-[4-(2,3-DIHYDROXY-PROPOXY)PHENYL]BUTYL-GUANIDINE METHANE-SULFONATE (552-02), A NOVEL EPITHELIAL SODIUM CHANNEL BLOCKER WITH POTENTIAL CLINICAL EFFICACY FOR CYSTIC FIBROSIS.

Hirsh1, A.J., Zhang2, J., Zamurs1, A., Fleegle1, J., Thelin3, W.R., Caldwell3, R.A., Sabater4, J.R., Abraham4, W.M., Donowitz5, M., Cha5, B., Johnson1, K.B., St. George1, J.A., Johnson1, M.R., and Boucher3, R.C. 1Parion Sciences Inc., Durham, North Carolina; 2Albany Molecular Research Inc., Albany, New York; 3Cystic Fibrosis/Pulmonary Research and Treatment Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 4Division of Pulmonary and Critical Care Medicine, University of Miami at Mount Sinai Medical Center, Miami Beach, Florida; and 5Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract

Amiloride improves mucociliary clearance (MC) by blocking airway epithelial sodium channels (ENaC) and expanding airway surface liquid (ASL). However, the low potency and rapid absorption of amiloride by airway epithelia translated into a short duration of efficacy as an aerosolized therapy for cystic fibrosis (CF) patients. To improve ENaC blocker CF pharmacotherapy, a more potent and durable ENaC blocker tailored for aerosol delivery was synthesized. Parion compound N-(3,5- diamino-6-chloropyrazine-2-carbonyl)-N’-4-[4-(2,3-dihydroxypropoxy) phenyl]butyl-guanidine methanesulfonate (552-02) was tested for potency and reversibility of ENaC block, epithelial absorption and biotrans-formation, selectivity, durability of ASL expansion under isotonic and hypertonic conditions in canine and human CF bronchial epithelial cells, and drug dissociation on ENaC in Xenopus oocytes. Short-circuit current assessed compound potency and reversibility, patch-clamp recordings of ENaC current assessed drug off-rate (koff), a gravimetric method and confocal microscopy measured mucosal water retention and ASL height, and drug absorption and biotransformation were assessed using liquid chromatography-mass spectrometry. Amiloride and 552-02 were tested in vivo for MC activity in sheep immediately and 4 to 6 h after aerosol dosing. Compared with amiloride, compound 552-02 was 60 to 100- fold more potent, it was 2 to 5-fold less reversible, it was slower at crossing the epithelium, and it exhibited a 170-fold slower koff value. 552-02 exhibited greater ASL expansion over 8 h in vitro, and it was more effective than amiloride at increasing MC immediately and 4 to 6 h after dosing. When combining hypertonic saline and 552-02, a synergistic effect on ASL expansion as measured in canine or CF bronchial epithelia. In summary, the preclinical data support the clinical use of 552-02 +/- hypertonic saline for CF lung disease.

Keywords

Biotransformation, CF lung pathophysiology, Drug absorption, HTBE, Human tracheobronchial epithelial cells, Na+/H+ exchange activity, Sodium channel absorption, Sodium-proton exchange assay

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