Autoreactive B cell-derived antibodies
form immune complexes that
likely play a pathogenic role in autoimmune diseases. In systemic
lupus erythematosus (SLE), these antibodies bind Fc receptors on myeloid
cells and induce proinflammatory cytokine production by monocytes
and NETosis by neutrophils. Bruton’s tyrosine kinase (BTK)
is a non-receptor tyrosine kinase that signals downstream of Fc receptors
and plays a transduction role in antibody expression following B cell
activation. Given the roles of BTK in both the production and sensing
of autoreactive antibodies, inhibitors of BTK kinase activity may
provide therapeutic value to patients suffering from autoantibody-driven
immune disorders. Starting from an in-house proprietary screening
hit followed by structure-based rational design, we have identified
a potent, reversible BTK inhibitor, BIIB068 (1), which
demonstrated good kinome selectivity with good overall drug-like properties
for oral dosing, was well tolerated across preclinical species at
pharmacologically relevant doses with good ADME properties, and achieved
>90% inhibition of BTK phosphorylation (pBTK) in humans.