OBJECTIVE: Infantile spasm syndrome (ISS) is an epileptic encephalopathy without established treatment after the failure to standard of care based on steroids and vigabatrin. Converging lines of evidence indicating a role of NR2B subunits of the N-methyl-D-aspartate (NMDA) receptor on the onset of spams in ISS patients, prompted us to test radiprodil, a negative allosteric NR2B modulator in preclinical seizure models and in infants with ISS. METHODS: Radiprodil has been tested in three models, including pentylenetetrazole-induced seizures in rats across different postnatal (PN) ages. Three infants with ISS have been included in a phase 1b escalating repeated dose study. RESULTS: Radiprodil showed the largest protective seizure effects in juvenile rats (maximum at PN12, corresponding to late infancy in humans). Three infants resistant to a combination of vigabatrin and prednisolone received individually titrated doses of radiprodil for up to 34 days. Radiprodil was safe and well tolerated in all three infants, and showed the expected pharmacokinetic profile. One infant became spasm-free and two showed clinical improvement without reaching spasm-freedom. After radiprodil withdrawal, the one infant continued to be spasm-free, while the two others experienced seizure worsening requiring the use of the ketogenic diet and other antiepileptic drugs. INTERPRETATION: Radiprodil showed prominent anti-seizure effect in juvenile animals, consistent with the prevalent expression of NR2B subunit of the NMDA receptor at this age in both rodents and humans. The clinical testing, although preliminary, showed that radiprodil is associated with a good safety and pharmacokinetic profile, and with the potential to control epileptic spasms.

• MeSH
• acetamidy aplikace a dávkování   škodlivé účinky   farmakokinetika   farmakologie   MeSH
• antikonvulziva aplikace a dávkování   škodlivé účinky   farmakokinetika   farmakologie   MeSH
• hodnocení výsledků zdravotní péče MeSH
• kojenec MeSH
• křeče u dětí farmakoterapie   MeSH
• krysa rodu Rattus MeSH
• lidé MeSH
• modely nemocí na zvířatech MeSH
• myši MeSH
• piperidiny aplikace a dávkování   škodlivé účinky   farmakokinetika   farmakologie   MeSH
• potkani Wistar MeSH
• receptory N-methyl-D-aspartátu antagonisté a inhibitory   MeSH
• refrakterní epilepsie farmakoterapie   MeSH
• zvířata MeSH
• Check Tag
• kojenec MeSH
• krysa rodu Rattus MeSH
• lidé MeSH
• mužské pohlaví MeSH
• myši MeSH
• ženské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky, fáze I MeSH
• práce podpořená grantem MeSH
• Názvy látek
• acetamidy MeSH
• antikonvulziva MeSH
• NR2B NMDA receptor MeSH Prohlížeč
• piperidiny MeSH
• radiprodil MeSH Prohlížeč
• receptory N-methyl-D-aspartátu MeSH