# US 2019/0167676 A1 · Methods for improving resistance to skeletal muscle fatigue

> Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt

- Number: US 2019/0167676 A1
- Document ID: US20190167676A1
- Status: Published application
- Kind: A1
- Application number: 16/206,747
- Filed: 2018-11-30
- Published: 2019-06-06
- Earliest claimed: 2012-04-11
- Assignees: Cytokinetics, Inc.
- Applicants: Cytokinetics, Inc.
- Inventors: Fady MALIK; Jeffrey R. JASPER; Adam KENNEDY; Darren T. HWEE
- Web page: https://patentgrep.com/patent/US20190167676A1

## CPC

- A61K 31/4985: Pyrazines or piperazines ortho- or peri-condensed with heterocyclic ring systems
- A61K 31/437: the heterocyclic ring system containing a five-membered ring having nitrogen as a ring hetero atom, e.g. indolizine, beta-carboline
- A61K 31/506: not condensed and containing further heterocyclic rings
- A61K 45/06: Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
- A61P 7/06: Antianaemics
- A61P 9/10: for treating ischaemic or atherosclerotic diseases, e.g. antianginal drugs, coronary vasodilators, drugs for myocardial infarction, retinopathy, cerebrovascula insufficiency, renal arteriosclerosis
- A61P 21/00: Drugs for disorders of the muscular or neuromuscular system
- A61P 43/00: Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
- A61K: PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES (devices or methods specially adapted for bringing pharmaceutical products into particular physical or administering forms A61J3/00; chemical aspects of, or use of materials for deodorisation of air, for disinfection or sterilisation, or for bandages, dressings, absorbent pads or surgical articles A61L; soap compositions C11D)
- A61P: SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS

## Abstract

Provided are compounds, compositions and methods for improving resistance to skeletal muscle fatigue comprising administering an effective amount of a skeletal muscle troponin activator. Also provided are methods for improving resistance to fatigue, improving physical endurance, or reducing exercise intolerance in a subject suffering from a condition associated with muscle fatigue or weakness, such as heart failure.

## Claims

### Claim 1

A method of improving resistance to skeletal muscle fatigue in a subject, the method comprising administering to the subject a therapeutically effective amount of a skeletal muscle troponin activator.

### Claim 2 (depends on 1)

The method of claim 1, wherein the subject is suffering from a condition selected from myocardial infarction, anemia and muscle ischemia.

### Claim 3 (depends on 1)

The method of claim 1, wherein the subject is suffering from heart failure.

### Claim 4

A method of improving resistance to fatigue in a skeletal muscle, the method comprising contacting the skeletal muscle with a skeletal muscle troponin activator.

### Claim 5 (depends on 1)

The method of claim 1, wherein the skeletal muscle troponin activator increases submaximal tension in the skeletal muscle.

### Claim 6 (depends on 1)

The method of claim 1, wherein the skeletal muscle troponin activator reduces the intracellular calcium required by the skeletal muscle to generate force.

### Claim at position 7

7-13. (canceled)

### Claim 14

A method for treating exercise intolerance in a patient suffering from heart failure comprising administering to the patient a therapeutically effective amount of a skeletal muscle troponin activator.

### Claim 15

A method for improving physical endurance performance of a patient suffering from heart failure, comprising administering to the subject a therapeutically effective amount of a skeletal muscle troponin activator.

### Claim 16

A method for increasing the function, activity, efficiency, sensitivity to calcium, or time to fatigue of skeletal muscle of a patient suffering from heart failure, comprising administering to the patient a therapeutically effective amount of a skeletal muscle troponin activator.

### Claim 17

A method for improving skeletal muscle function of a patient suffering from heart failure, comprising administering to the patient a therapeutically effective amount of a skeletal muscle troponin activator.

### Claim 18 (depends on 14)

The method of claim 14, further comprising administering to the subject a second therapy.

### Claim 19 (depends on 18)

The method of claim 18, wherein the second therapy is selected from an antiplatelet drug, a diuretic, a calcium channel blocker, a beta blocker, an ACE inhibitor, a statin, an angiotensin II receptor antagonist, and an aldosterone antagonist.

### Claim 20 (depends on 19)

The method of claim 19, wherein the second therapy is selected from digoxin, aspirin, ticlopidine, clopidogrel, metoprolol, carvedilol, eplerenone, and spironolactone.

### Claim 21 (depends on 18)

The method of claim 18, wherein the second therapy is selected from angioplasty, stenting, and surgery.

### Claim 22 (depends on 18)

The method of claim 18 wherein the skeletal muscle troponin activator and the second therapy are administered simultaneously to the subject.

### Claim 23 (depends on 18)

The method of claim 18 wherein the skeletal muscle troponin activator and the second therapy are administered sequentially to the subject.

### Claim 24 (depends on 1)

The method of claim 1, wherein the skeletal muscle troponin activator is a fast skeletal muscle troponin activator.

### Claim at position 19

25-26. (canceled)

### Claim 27 (depends on 1)

The method of claim 1, wherein the skeletal muscle troponin activator is selected from compounds of Formula I:
or a pharmaceutically acceptable salt thereof, wherein:
R1 is selected from hydrogen, halogen, CN, C1-6 alkyl, C1-6 haloalkyl, C(O)ORa, C(O)NRbRc, ORa, NRbRc, C6-10 aryl and 5-10 membered heteroaryl;
R2 is selected from C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, 5-10 membered heteroaryl and NRbRc, wherein each of the C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 substituents selected from halogen, CN, oxo, (CH2)nORa, (CH2)nOC(O)Ra, (CH2)nOC(O)ORa, (CH2)nOC(O)NRbRc, (CH2)nNRbRc, (CH2)NRdC(O)Ra, (CH2)nNRdC(O)ORa, (CH2)nNRdC(O)NRbRc, (CH2)nNRdC(O)C(O)NRbRc, (CH2)nNRdC(S)Ra, (CH2)nNRdC(S)ORa, (CH2)nNRdC(S)NRbRc, (CH2)nNRdC(NRe)NRbRc, (CH2)nNRdS(O)Ra, (CH2)nNRdSO2Ra, (CH2)nNRdSO2NRbRc, (CH2)nC(O)Ra, (CH2)nC(O)ORa, (CH2)nC(O)NRbRc, (CH2)nC(S)Ra, (CH2)nC(S)ORa, (CH2)nC(S)NRbRc, (CH2)nC(NRe)NRbRc, (CH2)nSRa, (CH2)nS(O)Ra, (CH2)nSO2Ra, (CH2)nSO2NRbRc, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, (CH2)nC3-8 cycloalkyl, (CH2)n3-8 membered heterocycloalkyl, (CH2)nC6-10 aryl and (CH2)n5-10 membered heteroaryl, wherein each of the C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, (CH2)nC3-8 cycloalkyl, (CH2)n3-8 membered heterocycloalkyl, (CH2)nC6-10 aryl and (CH2)n5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 Rf substituents;
R3 is selected from hydrogen, halogen, CN, C1-6 alkyl, C1-6 haloalkyl, C(O)ORa, C(O)NRbRc, ORa, NRbRc, C6-10 aryl and 5-10 membered heteroaryl;
R4 is selected from hydrogen, C1-6 alkyl, C1-6 haloalkyl, C(O)Ra, C(O)ORa, C(O)NRbRc and SO2Ra;
R5 and R6 are each independently selected from hydrogen, halogen, C1-6 alkyl and C1-6 haloalkyl;
or alternatively, R5 and R6 together with the carbon atom to which they are bound form a group selected from C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl and 3-8 membered heterocycloalkenyl, each optionally substituted with 1, 2, 3, 4 or 5 substituents selected from halogen, CN, oxo, ORa, OC(O)Ra, OC(O)ORa, NRbRc, C(O)Ra, C(O)ORa, C(O)NRbRc, S(O)Ra, SO2Ra, SO2NRbRc, C1-6 alkyl and C1-6 haloalkyl;
R7 is selected from C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl and 5-10 membered heteroaryl, each optionally substituted with 1, 2, 3, 4 or 5 substituents selected from halogen, CN, oxo, ORa, OC(O)Ra, OC(O)ORa, OC(O)NRbRc, NRbRc, NRdC(O)Ra, NRdC(O)ORa, NRdC(O)NRbRc, NRdC(O)C(O)NRbRc, NRdC(S)Ra, NRdC(S)ORa, NRdC(S)NRbRc, NRdC(NRc)NRbRc, NRdS(O)Ra, NRdSO2Ra, NRdSO2NRbRc, C(O)Ra, C(O)ORa, C(O)NRbRc, C(S)Ra, C(S)ORa, C(S)NRbRc, C(NRe)NRbRc, SRa, S(O)Ra, SO2Ra, SO2NRbRc, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl, and 5-10 membered heteroaryl, wherein each of the C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 Rf substituents;
R8 and R9, at each occurrence, are each independently selected from hydrogen, halogen and C1-6 alkyl;
X is selected from a bond, —(CH2)p—, —(CH2)pC(O)(CH2)q—, —(CH2)pO(CH2)q—, —(CH2)pS(CH2)q—, —(CH2)pNRd(CH2)q—, —(CH2)pC(O)O(CH2)q—, —(CH2)pOC(O)(CH2)q—, —(CH2)pNRdC(O)(CH2)q—, —(CH2)pC(O)NRd(CH2)q—, —(CH2)pNRdC(O)NRd(CH2)q—, —(CH2)pNRdSO2(CH2)q—, and —(CH2)pSO2NRd(CH2)q—;
or alternatively, X, R2 and R3, together with the carbon atoms to which they are bound, form a 5-6 membered ring optionally containing one or more heteroatoms selected from oxygen nitrogen and sulfur, and optionally containing one or more double bonds, and optionally substituted with 1, 2, 3, 4 or 5 Rf substituents;
Ra, at each occurrence, is independently selected from hydrogen, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl, wherein each of the C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 Rf substituents;
Rb and Rc, at each occurrence, are each independently selected from hydrogen, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl, 5-10 membered heteroaryl, C(O)Rg, C(O)ORg, C(O)NRiRj and SO2Rg, wherein each of the C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 Rf substituents;
Rd, at each occurrence, is independently selected from hydrogen and C1-6 alkyl;
Re, at each occurrence, is independently selected from hydrogen, CN, OH, C1-6 alkoxy, C1-6 alkyl and C1-6 haloalkyl;
Rf, at each occurrence, is independently selected from halogen, CN, ORh, OC(O)Rh, OC(O)ORh, OC(O)NRiRj, NRiRj, NRdC(O)Rh, NRdC(O)Rh, NRdC(O)NRiRj, NRdC(O)C(O)NRiRj, NRdC(S)Rh, NRdC(S)ORh, NRdC(S)NRiRj, NRdC(NRe)NRiRj, NRdS(O)Rh, NRdSO2Rh, NRdSO2NRiRj, C(O)Rh, C(O)ORh, C(O)NRiRj, C(S)Rh, C(S)ORh, C(S)NRiRj, C(NRe)NRiRj, SRh, S(O)Rh, SO2Rh, SO2NRiRj, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl, wherein each of the C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 Rk substituents;
or two Rf substituents bound to a single carbon atom, together with the carbon atom to which they are both bound, form a group selected from carbonyl, C3-8 cycloalkyl and 3-8 membered heterocycloalkyl;
Rg, at each occurrence, is independently selected from C1-6 alkyl, C1-6 haloalkyl, phenyl, naphthyl, and C7-11 aralkyl, each optionally substituted with 1, 2, 3, 4 or 5 substituents selected from halogen, CN, OH, C1-6 alkoxy, C1-6 alkyl and C1-6 haloalkyl;
Rh, at each occurrence, is independently selected from hydrogen, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl, wherein each of the C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 Rk substituents;
Ri and Rj, at each occurrence, are each independently selected from hydrogen, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl, 5-10 membered heteroaryl, C(O)Rg, and C(O)ORg, wherein each of the C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, C2-6 alkynyl, C3-8 cycloalkyl, C3-8 cycloalkenyl, 3-8 membered heterocycloalkyl, 3-8 membered heterocycloalkenyl, C6-10 aryl, C7-11 aralkyl and 5-10 membered heteroaryl groups is optionally substituted with 1, 2, 3, 4 or 5 substituents selected from halogen, CN, OH, C1-6 alkoxy, C1-6 alkyl and C1-6 haloalkyl;
Rk, at each occurrence, is independently selected from halogen, CN, OH, C1-6 alkoxy, NH2, NH(C1-6 alkyl), N(C1-6 alkyl)2, NHC(O)C1-6 alkyl, NHC(O)C7-11 aralkyl, NHC(O)OC1-6 alkyl, NHC(O)OC7-11 aralkyl, OC(O)C1-6 alkyl, OC(O)C7-11 aralkyl, OC(O)OC1-6 alkyl, OC(O)OC7-11 aralkyl, C(O)C1-6 alkyl, C(O)C7-11 aralkyl, C(O)OC1-6 alkyl, C(O)OC7-11 aralkyl, C1-6 alkyl, C1-6 haloalkyl, C2-6 alkenyl, and C2-6 alkynyl, wherein each C1-6 alkyl, C2-6 alkenyl, C2-6 alkynyl, and C7-11 aralkyl substituent is optionally substituted with 1, 2 or 3 substituents selected from OH, C1-6 alkoxy, NH2, NH(C1-6 alkyl), N(C1-6 alkyl)2, NHC(O)C1-6 alkyl, NHC(O)C7-11 aralkyl, NHC(O)OC1-6 alkyl, and NHC(O)OC7-11 aralkyl;
or two Rk substituents bound to a single carbon atom, together with the carbon atom to which they are both bound, form a carbonyl group;
m is 0, 1 or 2;
n, at each occurrence, independently is 0, 1 or 2;
p is 0, 1 or 2; and
q is 0, 1 or 2.

### Claim at position 21

28-34. (canceled)

### Claim 35 (depends on 27)

The method of claim 27, wherein the compound of Formula I, or the pharmaceutically acceptable salt thereof, is a compound of Formula XII(o):
or a pharmaceutically acceptable salt thereof, wherein:
R1 is hydrogen;
R2 is selected from furanyl, pyrrolyl, thiophenyl, thiazolyl, isothiazolyl, thiadiazolyl, oxazolyl, isoxazolyl, oxadiazolyl, imidazolyl, triazolyl and tetrazolyl, each optionally substituted with
(CH2)nC(O)NH2;
R3 is hydrogen;
R4 is hydrogen;
R8 and R9 are each hydrogen;
one of Rm and Rn is hydrogen and the other is fluorine;
Rf, at each occurrence, is independently halogen;
n is 0, 1 or 2; and
r is 0, 1, 2, 3 or 4.

### Claim 36 (depends on 35)

The method of claim 35, wherein one of Rm and Rn is hydrogen and the other is fluorine; and
the fluorine and the pyridyl ring are in a trans configuration with respect to one another on the cyclobutyl ring.

### Claim 37 (depends on 27)

The method of claim 27, wherein the compound of Formula I, or the pharmaceutically acceptable salt thereof, is
1-(2-(((trans)-3-fluoro-1-(3-fluoropyridin-2-yl)cyclobutyl)methylamino)pyrimidin-5-yl)-1H-pyrrole-3-carboxamide, or a pharmaceutically acceptable salt thereof, wherein
1-(2-(((trans)-3-fluoro-1-(3-fluoropyridin-2-yl)cyclobutyl)methylamino)pyrimidin-5-yl)-1H-pyrrole-3-carboxamide is defined by the following structure: