Evaluation of Safety, Tolerability, Pharmacokinetics, Food Effect and Interaction With Midazolam in Healthy Volunteers After Oral Single and Multiple Ascending Dosing of KAND145

The goal of this study is to learn more about the study candidate drug, KAND145, when given to healthy volunteers. The study will consist of two parts. In Part 1, the goal is to find out if the study drug KAND145 is safe and tolerable after a single dose. First, a small group of participants will receive a liquid for swallowing containing a low dose of the study drug or a liquid for swallowing that does not contain any drug. If this is safe and tolerable, higher doses will be given to subsequent groups of participants. Additionally, the effect of food on the metabolism of the study drug will be studied. In Part 2, the goal is to find out how the body absorbs, distributes, and gets rid of the study drug when it is taken twice a day for 8 days. As in Part 1, first a liquid for swallowing containing a low dose of the study drug or a liquid for swallowing that does not contain any study drug will be given to a first group of participants; additional doses will then be given to subsequent groups of participants. Additionally, it will be studied if the study drug KAND145 affects the pharmacokinetics of the medicine midazolam.

This is a Phase 1, first-in-human (FIH), single-center, placebo-controlled, randomized, double-blind study in healthy subjects to evaluate safety, tolerability, PK, food effect (FE) and interaction with midazolam after oral single ascending dosing (SAD; Part 1 of the study) and multiple ascending dosing (MAD; Part 2 of the study) of KAND145. A Safety Review Committee (SRC) will evaluate safety data from each dose cohort before proceeding with the subsequent cohort.

The study population will consist of healthy adult male and female volunteers. Up to 88 participants (up to 48 participants in Part 1, up to 40 participants in Part 2) are planned to be enrolled in the study, at one investigational site.

Part 1: In this part, participants receive single doses of KAND145 or placebo. Four ascending dose levels (cohorts) are planned; this may be extended with up to 2 optional dosing cohorts. In one cohort, a potential food interaction will be studied in the FE-part.

Part 2: In this part, participants receive KAND145 or placebo twice a day (BID) for 8 consecutive days. Two ascending dose levels (cohorts) are planned; this may be extended with up to 3 optional dose levels (cohorts). To find out whether KAND145 has an effect on CYP3A4-mediated drug metabolism, the interaction of KAND145/placebo with midazolam will be studied in two cohorts.

Eligibility Criteria:
Inclusion Criteria:

1. Provision of written informed consent prior to any other study specific procedures.
2. Body weight \>50 kg.
3. BMI ≥19.0 and \<30.0 kg/m\^2 at screening.
4. Healthy male and female subjects aged \>18 and \<65 years at screening.
5. Male subjects must agree to use an adequate method of contraception; Male subjects who are heterosexually active must use a condom with their partner, from the time of IMP administration until 72 hours after dosing of IMP, AND from the time of IMP administration until 90 days after dosing of IMP at least one of the following highly effective contraception methods (as per the Clinical Trial Facilitation Group, guidelines, 21/09/2020 Version 1.1) must be used by their female sexual partner:

   1. Combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation (oral, intravaginal or transdermal)
   2. Progestogen-only hormonal contraception associated with inhibition of ovulation (oral, injectable or implantable)
   3. Intrauterine device
   4. Intrauterine hormone-releasing system
   5. Bilateral tubal occlusion or hysterectomy
   6. Vasectomized male Or if the male subject has a post-menopausal partner.
6. Female subjects must be of non-childbearing potential (defined as pre-menopausal females with a documented tubal ligation or hysterectomy or bilateral oophorectomy; or as post-menopausal females defined as 12 months' amenorrhea \[in questionable cases, a blood sample with simultaneous follicle stimulating hormone 25-140 IU/L and estradiol \<200 pmol/L is confirmatory\]).

   Female subjects of childbearing potential may be included if it is their preferred and permanent lifestyle to abstain from heterosexual relationships, and if they agree to continue such abstinence and to avoid starting of a pregnancy during their study participation.
7. Willingness and ability to comply with study procedures, visit schedules, study restrictions and requirements.

Exclusion Criteria:

1. Present or known history of clinically significant cardio- or cerebrovascular, pulmonary, renal, hepatic, neurological, mental, metabolic, endocrine, hematologic, or gastrointestinal disorder, significant respiratory disease, sleep apnea, narcolepsy or any other major disorder that may interfere with the objectives of the study, as judged by the Investigator.
2. Any clinically significant abnormalities in physical examination, ECG (e.g., QTcF\>450 ms for males/\>460 ms for females), clinical chemistry, hematology, or urinalysis results at screening, as judged by the Investigator.
3. Clinically significant abnormal blood pressure, defined as systolic blood pressure above or equal to 160 mmHg and/or diastolic blood pressure above or equal to 90 mmHg at screening.
4. Pulse rate \<45 beats per minute at screening.
5. Clinically significant illness within the 5 days prior to the administration of the IMP.
6. Any positive result on screening for serum hepatitis B surface antigen, hepatitis C antibody or human immunodeficiency virus.
7. Known or suspected current or history of (within the most recent 5 years) drug or alcohol abuse or positive screen for drugs of abuse test or positive alcohol breath test at screening visit or any time prior to randomization.
8. Smoking \>5 cigarettes per day (or equivalent consumption of other nicotine-containing products), or inability to refrain from smoking or using other nicotine-containing products during the stay at the study clinic.
9. Subject who has received any investigational drug within the last 3 months before administration of IMP, or who has received any dose of KAND567 in a previous clinical study.
10. Plasma donation within 1 month of the screening visit, or any blood donation/blood loss \>450 mL during the 3 months prior to the screening visit.
11. Use of the herbal remedy St. John's Wort during 2 weeks prior to administration of the IMP (induces cytochrome P450-3A4).
12. Use of prescribed medication during 2 weeks prior to the administration of the IMP (or longer if the prescribed medication has a half-life long enough to potentially expose the subject to any significant systemic exposure, as judged by the Investigator).
13. Use of over the counter drugs (including herbals) during 1 week prior to the administration of the IMP or need for concomitant medications during the study. However, use of the following may be allowed: occasional paracetamol for pain relief (up to 3 g per 24 hours), vitamin D (up to 20 μg per 24 hours), supplementation therapy with thyroxin, iron, calcium, folate, estrogen, vitamin B12, and other vitamins and minerals at recommended doses, as judged by the Investigator. Intake of preparations containing iron, calcium or other metal ions will not, however, be permitted in the 10 hours preceding and 4 hours following IMP intake. Thus, their use cannot be allowed during the treatment period of Part 2.
14. Female subjects: Positive pregnancy test at screening visit or at any time prior to dosing.
15. Investigator considers the subject unlikely to comply with study procedures, restrictions, and requirements.