Identification of CNS-Penetrant Aryl Sulfonamides as Isoform-Selective NaV1.6 Inhibitors with Efficacy in Mouse Models of Epilepsy

J Med Chem. 2019 Nov 14;62(21):9618-9641. doi: 10.1021/acs.jmedchem.9b01032. Epub 2019 Oct 3.

Abstract

Nonselective antagonists of voltage-gated sodium (NaV) channels have been long used for the treatment of epilepsies. The efficacy of these drugs is thought to be due to the block of sodium channels on excitatory neurons, primarily NaV1.6 and NaV1.2. However, these currently marketed drugs require high drug exposure and suffer from narrow therapeutic indices. Selective inhibition of NaV1.6, while sparing NaV1.1, is anticipated to provide a more effective and better tolerated treatment for epilepsies. In addition, block of NaV1.2 may complement the anticonvulsant activity of NaV1.6 inhibition. We discovered a novel series of aryl sulfonamides as CNS-penetrant, isoform-selective NaV1.6 inhibitors, which also displayed potent block of NaV1.2. Optimization focused on increasing selectivity over NaV1.1, improving metabolic stability, reducing active efflux, and addressing a pregnane X-receptor liability. We obtained compounds 30-32, which produced potent anticonvulsant activity in mouse seizure models, including a direct current maximal electroshock seizure assay.

MeSH terms

  • Amides / chemistry*
  • Animals
  • Central Nervous System / metabolism*
  • Dogs
  • Epilepsy / drug therapy*
  • Hep G2 Cells
  • Humans
  • Madin Darby Canine Kidney Cells
  • Mice
  • Models, Molecular
  • NAV1.6 Voltage-Gated Sodium Channel / chemistry
  • NAV1.6 Voltage-Gated Sodium Channel / metabolism*
  • Protein Domains
  • Protein Isoforms / antagonists & inhibitors
  • Protein Isoforms / chemistry
  • Protein Isoforms / metabolism
  • Sodium Channel Blockers / chemistry
  • Sodium Channel Blockers / metabolism*
  • Sodium Channel Blockers / pharmacology*
  • Sodium Channel Blockers / therapeutic use
  • Structure-Activity Relationship

Substances

  • Amides
  • NAV1.6 Voltage-Gated Sodium Channel
  • Protein Isoforms
  • Scn8a protein, mouse
  • Sodium Channel Blockers