REDX08608, a Novel, Potent and Selective, Reversible BTK Inhibitor with Efficacy and Equivalent Potency Against Wild-Type and Mutant C481S BTK
Authors: Guisot Nicolas E. S. , Best Stuart A. , Wright Victoria , Thomason Andrew , Woyach Jennifer A. , Mantel Rose , McClanahan Fabienne , Abet Valentina , Castagna Diana , Cousin Peggy , Emmerich Juliette , Ho Kelvin , Kelly James Russell , King-Tours James , Lyons Kristina , Muller Melanie , Refuerzo Julienne , Sargent Louise , Talab Fatima , Bingham Matilda , Phillips Caroline , Armer Richard 
Published: October 2019

Abstract
Here we report the preclinical profile of REDX08608 our novel, potent and selective, reversible BTK inhibitor that is equipotent against wild-type and mutant C481S BTK.
Bruton's tyrosine kinase (BTK) is a member of the src-related Tec family of cytoplasmic tyrosine kinases and plays a key role in the BCR signaling pathway, which is required for the development, activation and survival of B-cells. BTK is a clinically validated target to treat B-cell malignancies that are dependent on BCR signaling i.e.CLL and NHL with ibrutinib approved for the treatment of CLL, MCL and WM. Irreversible and covalent reversible BTK inhibitors such as ibrutinib, acalabrutinib and GS-4059 specifically target a cysteine residue C481 within BTK and mutations at this site clearly interfere with covalent drug binding. C481S, C481Y, C481R, C481F mutations have been reported and linked to cases of resistance that have emerged in patients with CLL progression following treatment with ibrutinib (Byrd2016, Inhye2016, Maddocks2015, Woaych2014). Redx reversible BTK inhibitor, REDX08608, aims to overcome this resistance mechanism by targeting both wild type and C481-mutated BTK. Redx have recently presented REDX06961 our BTK probe (Guisot2016, AACR#4795) and, following lead optimization, we are now disclosing REDX08608, our lead compound, a potent, reversible and selective BTK inhibitor, which displays an improved profile including superior pharmacokinetics.
REDX08608, reversibly, inhibits WT and C481S BTK and displays nanomolar binding affinity and potency in biochemical and cellular-based assays.
REDX08608 inhibits BTK signaling and growth in cell lines dependent on the BTK pathway such the OCI-LY10 ABC-DLBCL cell line. Importantly, REDX08608 also inhibits BTK signaling in primary CLL cells. In human whole blood and isolated human PBMCs, REDX08608 inhibits activation of B-cells at nanomolar concentrations measured by inhibition of immunoglobulin-induced CD69 in CD19+cells.
REDX08608 is highly selective when tested against a panel of 468 kinases and exhibits improved target specificity with >100-fold selectivity against other Tec and Src kinase family members (ITK, TXK, BMX, TEC, BLK, CSK, FYN, HCK, LCK, SRC) and >400-fold selectivity against EGFR.
REDX08608 was fully profiled through DMPK in vitro assays including metabolic stability, plasma stability, cytochrome P450 inhibition, PXR activation/cytochrome P450 activity, time dependent inhibition and cytochrome P450 reaction phenotyping. REDX08608 was shown to have an acceptable metabolic and plasma stability profile across species (mouse, rat, dog, monkey and human). REDX08608 displayed no evidence of PXR activation or time dependent inhibition. IC50s were determined for human cytochrome P450s (1A2, 2D6, 2C9, 2C19 and 3A4) and were all >10 µM. Good exposure, oral bioavailability and half-life were demonstrated for REDX08608 in mouse, rat and dog, with dose linearity assessment performed in mouse (F = 73-100%, CL= 11% liver blood flow in mice; F = 55-84%, CL = 28% liver blood flow in rat; F = 85%, CL= 10% liver blood flow in dog). In vivo efficacy studies in preclinical models will also be disclosed.
In conclusion, REDX08608 is a potent and selective, reversible BTK inhibitor with efficacy in lymphoma cell lines that offers the potential to target both wild-type BTK and an important emerging resistance mechanism in patients with CLL progression following ibrutinib-treatment.

Disclosures
Guisot: Redx Oncology Ltd - Redx Pharma Plc: Employment. Best:Redx Oncology Ltd - Redx Pharma Plc: Employment. Wright:Redx Oncology Ltd - Redx Pharma Plc: Employment. Thomason:Redx Oncology Ltd - Redx Pharma Plc: Employment. Woyach:Acerta: Research Funding; Karyopharm: Research Funding; Morphosys: Research Funding. Abet:Redx Oncology Ltd - Redx Pharma Plc: Employment. Castagna:Redx Oncology Ltd - Redx Pharma Plc: Employment. Cousin:Redx Oncology Ltd - Redx Pharma Plc: Employment. Emmerich:Redx Oncology Ltd - Redx Pharma Plc: Employment. Ho:Redx Oncology Ltd - Redx Pharma Plc: Employment. Kelly:Redx Oncology Ltd - Redx Pharma Plc: Employment. King-Tours:Redx Oncology Ltd - Redx Pharma Plc: Employment. Lyons:Redx Oncology Ltd - Redx Pharma Plc: Employment. Muller:Redx Oncology Ltd - Redx Pharma Plc: Employment. Refuerzo:Redx Oncology Ltd - Redx Pharma Plc: Employment. Sargent:Redx Oncology Ltd - Redx Pharma Plc: Employment. Talab:Redx Oncology Ltd - Redx Pharma Plc: Employment. Bingham:Redx Oncology Ltd - Redx Pharma Plc: Employment. Phillips:Redx Oncology Ltd - Redx Pharma Plc: Employment. Armer:Redx Oncology Ltd - Redx Pharma Plc: Employment.