Efficacy and safety of HERG channel agonists for treatment of Long QT Syndrome type 8

Abstract Background Substrate-based approach aimed at repolarization abbreviaton using mexiletine was shown to normalize the QTc interval and reduce the event rate in LQT3, and is now considered standard-of-care. Unfortunately, mexiletine is partially efficacious in other malignant forms of LQTS, such as LQT2 and LQT8. Novel compounds, such as HERG channel agonists, potentially capable of safely and efficaciously abbreviating the repolarization have not been tested in a clinically relevant model. Purpose To investigate the efficacy and safety of repolarization shortening using ICA-105574, the most potent compound belonging to the class of HERG channel agonists, in a clinically relevant, first-in-class porcine model of LQT8. Methods We used a combination of 12-lead ECG and electroanatomical mapping (EAM) to obtain data on the QTc interval, local activation time (LAT), local repolarization time (LRT) and its gradients, and reentrant vulnerability index (RVI), at baseline and after drug administration. We used LQT8 pigs of both genders weighing between 60 kg and 80 kg. All procedures were conducted following local regulations for the care and use of laboratory animals after authorization by relevant authorities. We used mixed effects linear regression model to assess the effect of ICA-105574 on the QTc interval and paired nested t-test to assess the effect of ICA-105574 on EAM-derived parameters. Results As a first step, we assessed the effects of ICA-105574 on the QTc interval. Compared to baseline, a single dose of 3 mg/kg of ICA-105574 resulted in an immediate and pronounced shortening of the QTc interval in all animals (∆QTc at 5 minutes post-injection: -28%, p