Roberto Narducci, Andrea Armirotti, Andrea Contestabile, Rosalia Bertorelli, Maria Summa, Marco De Vivo, Laura Cancedda, Giuseppina La Sala, Annalisa Savardi, Jose Antonio Ortega, and Marco Borgogno
Summary Aberrant expression ratio of Cl− transporters, NKCC1 and KCC2, is implicated in several brain conditions. NKCC1 inhibition by the FDA-approved diuretic drug, bumetanide, rescues core symptoms in rodent models and/or clinical trials with patients. However, bumetanide has a strong diuretic effect due to inhibition of the kidney Cl− transporter NKCC2, creating critical drug compliance issues and health concerns. Here, we report the discovery of a new chemical class of selective NKCC1 inhibitors and the lead drug candidate ARN23746. ARN23746 restores the physiological intracellular Cl− in murine Down syndrome neuronal cultures, has excellent solubility and metabolic stability, and displays no issues with off-target activity in vitro. ARN23746 recovers core symptoms in mouse models of Down syndrome and autism, with no diuretic effect, nor overt toxicity upon chronic treatment in adulthood. ARN23746 is ready for advanced preclinical/manufacturing studies toward the first sustainable therapeutics for the neurological conditions characterized by impaired Cl− homeostasis., Graphical Abstract, Highlights • NKCC1 is a promising target for the treatment of brain disorders • The newly discovered ARN23746 presents selective NKCC1 versus NKCC2 and KCC2 inhibition • ARN23746 restores altered neuronal chloride homeostasis in vitro • ARN23746 rescues core behaviors in DS and ASD mice with no diuretic effect or toxicity, The Bigger Picture In the last few decades, drug development for brain disorders has struggled to deliver effective small molecules as novel breakthrough classes of drugs. Discovery of effective chemical compounds for brain disorders has been greatly hampered by the fact that the few currently clinically used drugs were identified by serendipity, and these drugs’ mechanism of action is often poorly understood. Here, by leveraging drug repurposing as a means to quickly and safely evaluate the new pharmacological target NKCC1 and its implications in brain disorders in animal models and patients, we report an integrated strategy for the rational design and discovery of a novel, selective, and safe NKCC1 inhibitor, active in vivo. This compound has the potential to become a clinical drug candidate to treat several neurological conditions in patients. Eventually, this integrated drug-discovery strategy has the prospective to revive the appeal of drug-discovery programs in the challenging field of neuroscience., Currently, therapeutic options for several neurological disorders are scant or not highly effective. This is possibly due to the poor understanding of the mechanisms underlying these conditions. Here, starting from former validation of the new pharmacological target NKCC1 in brain disorders, we developed a novel, potent, and safe NKCC1 inhibitor, able to restore core behaviors in Down syndrome and autistic mouse models. This compound has the potential to become a solid drug candidate for the treatment of several neurological conditions.