AIMSSelisistat, a selective SirT1 inhibitor is being developed as a potentially disease-modifying therapeutic for Huntington's disease (HD). This was the first study of selisistat in HD patients and was primarily aimed at development of pharmacodynamic biomarkers.
METHODSThis was a randomized, double-blind, placebo-controlled, multicentre exploratory study. Fifty-five male and female patients in early stage HD were randomized to receive 10 mg or 100 mg of selisistat or placebo once daily for 14 days. Blood sampling, clinical and safety assessments were conducted throughout the study. Candidate pharmacodynamic markers included circulating soluble huntingtin and innate immune markers.
RESULTSSelisistat was found to be safe and well tolerated, and systemic exposure parameters showed that the average steady-state plasma concentration achieved at the 10 mg dose level (125 nM) was comparable with the IC50 for SirT1 inhibition. No adverse effects on motor, cognitive or functional readouts were recorded. While circulating levels of soluble huntingtin were not affected by selisistat in this study, the biological samples collected have allowed development of assay technology for use in future studies. No effects on innate immune markers were seen.
CONCLUSIONSSelisistat was found to be safe and well tolerated in early stage HD patients at plasma concentrations within the anticipated therapeutic concentration range.
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Modulation of the acetylation status of mutant huntingtin via SirT1 inhibition has been shown to restore transcriptional dysregulation in models of Huntington's disease (HD).• Both nicotinamide and butyrate inhibit SirT1, but have insufficient potency and selectivity to test the SirT1 concept in patients with HD.
WHAT THIS STUDY ADDS• This was the first study with a selective SirT1 inhibitor in HD patients and shows that SirT1 inhibition is safe and well tolerated at plasma exposure levels providing benefit in non-clinical HD models, creating the basis for further studies of the pharmacodynamics of SirT1 modulation.