# US 2022/0033397 A1 · Pharmaceutical compounds and their use as inhibitors of ubiquitin specific protease 19 (usp19)

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- Number: US 2022/0033397 A1
- Document ID: US20220033397A1
- Status: Published application
- Kind: A1
- Application number: 17/299,959
- Filed: 2019-12-06
- Published: 2022-02-03
- Earliest claimed: 2018-12-06
- Assignees: Almac Discovery Limited
- Applicants: Almac Discovery Limited
- Inventors: James Samuel Shane ROUNTREE; Steven Kristopher WHITEHEAD; Adam Piotr TREDER; Lauren Emma PROCTOR; Steven David SHEPHERD; Frank BURKAMP; Joana Rita Castro COSTA; Colin O'DOWD; Timothy HARRISON; Matthew Duncan HELM; Ewelina ROZYCKA; Aaron CRANSTON; Xavier JACQ
- Web page: https://patentgrep.com/patent/US20220033397A1

## CPC

- C07D 471/04: Ortho-condensed systems
- A61P 3/04: Anorexiants; Antiobesity agents
- A61P 3/10: for hyperglycaemia, e.g. antidiabetics
- A61P 21/00: Drugs for disorders of the muscular or neuromuscular system
- A61P 35/00: Antineoplastic agents
- C07D 401/06: linked by a carbon chain containing only aliphatic carbon atoms
- C07D 401/14: containing three or more hetero rings
- C07D 405/14: containing three or more hetero rings
- C07D 413/06: linked by a carbon chain containing only aliphatic carbon atoms
- C07D 413/14: containing three or more hetero rings
- C07D 417/14: containing three or more hetero rings
- C07D 487/04: Ortho-condensed systems
- C07D 491/048: the oxygen-containing ring being five-membered
- C07D 495/04: Ortho-condensed systems
- C07D 498/04: Ortho-condensed systems
- C07D: HETEROCYCLIC COMPOUNDS (macromolecular compounds C08)
- A61P: SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS

## Abstract

Provided are USP19 inhibitors, methods of treating obesity, metabolic syndrome and/or diabetes using the USP19 inhibitor compounds, as well as those compounds for use in methods of treating obesity, metabolic syndrome and/or diabetes. Also provided are methods of treating muscular atrophy, for example cachexia or sarcopenia with USP19 inhibitor compounds, plus those a compounds for use in methods of treating muscular atrophy.

## Claims

### Claim 1

A compound of formula (I):
wherein
R1 is optionally substituted C1-C6 alkyl, optionally substituted C4-C10 alkylcycloalkyl, optionally substituted C6-C10 alkylaryl, optionally substituted C5-C8 aryl, optionally substituted C3-C8 heteroaryl, optionally substituted C3-C8 heterocycloalkyl, NRaRb, NRaCH2Rb, ORa, or OCH2Ra
wherein Ra and Rb are independently selected from H, C1-C6 alkyl, CF3, optionally substituted C3-C6 cycloalkyl, optionally substituted C5-C8 aryl, optionally substituted C6-C9 arylalkyl, and optionally substituted C2-C8 heteroaryl, and
wherein when R1 is NRaCH2Rb, the methylene group may be optionally substituted with CF3,
or R1 is NRaRb and Ra and Rb together form an optionally substituted C2-C9 heterocycle together with the N to which they are attached;
R2 and R3 are independently selected from H, and C1-C6 alkyl, or together form a C3-C6 cycloalkyl or C3-C6 heterocycloalkyl with the carbon to which they attached;
X is absent, C, CR4a, CR4aR4b, N, NR4a, or C═O,
wherein R4a and R4b are independently selected from H, optionally substituted C1-C6 alkyl and halo;
or wherein R4a and R4b together form a C3-C6 cycloalkyl or C3-C6 heterocycloalkyl including the carbon to which they are attached;
Y is C, CR5, CR5R6, N, NR5, or O,
wherein R5 and R6 are independently selected from H, halo, optionally substituted C1-C6 alkyl, optionally substituted C3-C6 cycloalkyl, optionally substituted C3-C6 heterocycloalkyl, optionally substituted C5-C8 aryl, optionally substituted C6-C9 arylalkyl, optionally substituted C3-C8 heteroaryl, CH2OH, NR′R″, NS(O)R′R″, SO2R′, C(O)R′, COR′, C(O)OR′, C(O)NR′R″, OR′, wherein R′ and R″ are independently selected from H, C1-C6 alkyl, C5-C8 aryl, C6-C9 arylalkyl, and C3-C8 heteroaryl, or wherein R5 is NR′R″ and R′ and R″ together form an optionally substituted C3-6 heterocycloalkyl including the nitrogen to which they are attached,
or wherein R5 and R8 together form a C3-6 cycloalkyl or C3-C6 heterocycloalkyl including the carbon to which they are attached;
Z is N, NR7, C, CR7, CR7R8, or C═O,
wherein R7 and R8 are independently selected from H, halo, C1-C6 alkyl, C2-C6 alkene, C2-C6 alkyne, C3-C6 cycloalkyl, optionally substituted C3-C6 heterocycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C3-C8 heteroaryl, CN, C(O)ORc, CONRcRd, NRcRd, NS(O)RcRd, S(O)(Rc)NRd, SORc, SO2Rc, and SRc, wherein Rc and Rd are independently H, C1-C6 alkyl, C3-C6 cycloalkyl, C5-C6 aryl, C6-C9 arylalkyl, C3-C6 heteroaryl, CN, COOH, or COCH3 or Rc and Rd together form an optionally substituted C3-C7 heterocycle together with the heteroatom to which they are attached;
or wherein R7 and R8 together form a C3-6 cycloalkyl or C3-C6 heterocycloalkyl including the carbon to which they are attached;
M is absent, C, CR13 or CR13R14, wherein R13 and R14 are independently selected from H, and C1-C6 alkyl, or wherein R13 and R14 together form a C3-C6 cycloalkyl or C3-C6 heterocycloalkyl together with the carbon to which they are attached;
and
A is CR9, CHR9, N, NR9, S, or O;
D is CR9, CHR9, N or NR9,
G is absent, CR9, CHR9, or N,
wherein R9 is independently selected from H, halo, C1-C6 alkyl, CF3, and OR*, wherein R* is selected from optionally substituted C1-C6 alkyl, optionally substituted C3-C6 cycloalkyl, and optionally substituted C3-C6 heterocycloalkyl,
E is CR10, CHR10, N, NR10, S, or O,
wherein R10 is selected from H, halo, C1-C6 alkyl, C3-C6 cycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C4-C8 heteroaryl, SRx, ORx, NRxRy, and NS(O)RxRy, S(O)(Rx)NRy
wherein Rx and Ry are independently selected from H, C1-C6 alkyl, CF3, C3-C6 cycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C4-C8 heteroaryl, COOH, amido, cyano, C2-C6 alkene, C2-C6 alkyne, or wherein Rx and Ry together form an optionally substituted C4-C6 heterocycloalkyl together with the nitrogen to which they are attached;
or A, D, E and G are all absent, optionally wherein X and M are absent, or optionally wherein Y and Z together form an optionally substituted C5-C6 aryl or C5-C6 heteroaryl fused ring or Z and M together form an optionally substituted C5-C6 aryl or C5-C6 heteroaryl fused ring;
or a stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt thereof.

### Claim 2 (depends on 1)

A compound of formula (Ia),
wherein Q is selected from CR11, or CR11R12, NR11 or O, where R11 and R12 are independently selected from H, OH, C1-C6 alkyl, CF3, C3-C6 cycloalkyl, optionally substituted C5-C8 aryl, C4-C8 heteroaryl, or wherein R11 and R12 together form an optionally substituted C3-C5 carbocycle together with the C to which they are attached,
and wherein each of X, Y, Z and M are present and as defined in claim 1, wherein the ring QXYZM is aliphatic or aromatic, preferably aliphatic;
and wherein R1, R2, and R3 are as defined in claim 1;
or a stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt thereof.

### Claim 3 (depends on 1, 2)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 1 or claim 2, wherein for each optionally substituted group, each one or more optional substituent is independently selected from C1-C4 alkyl, C3-C4 cycloalkyl, halo, CHF2, CF3, hydroxyl, NH2, NO2, CH2OH, CH2OCH3, methoxy, OCHF2, OCF3, cyclopropyloxy, phenyl, fluoro-substituted phenyl, benzyl, and oxo.

### Claim 4 (depends on 1, 2, 3)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1-3, wherein R1 is optionally substituted ethylbenzene, optionally substituted ethylcyclohexyl, optionally substituted ethylcyclobutyl or optionally substituted trifluoropropyl.

### Claim 5 (depends on 4)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 4, wherein each optional substituent is selected from methyl, and CH2OH.

### Claim 6 (depends on 1, 2, 3)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1-3, wherein R1 is NRaRb or NRaCH2Rb, wherein Ra and Rb are independently selected from H, methyl, ethyl, propyl, CF3, optionally substituted cyclopropyl, optionally substituted cyclobutyl, optionally substituted cycopentyl, optionally substituted cyclohexyl, optionally substituted phenyl, optionally substituted benzyl, optionally substituted pyridinyl, pyrazole, imidazole, furan, benzodioxol, optionally substituted oxadiazole, thiazole, and thiophene, wherein the optional substituents are independently selected from halo, methyl, cyclopropyl and CN,
optionally wherein R1 is NRaCH2Rb and the methylene group is substituted with CF3;
or R1 is NRaRb and wherein Ra and Rb together form an optionally substituted C3-C9 heterocycle together with the N to which they are attached, optionally substituted with OH, CH2OH, CH2OCH3, oxo, NH, NH2, methyl, ethyl, propyl, spirocyclopropyl, CF3, phenyl, fluoro-substituted phenyl, or benzyl.

### Claim 7 (depends on 6)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 6, wherein R1 is NRaRb and Ra and Rb form a heterocycle together with the N to which they are attached, wherein the heterocycle is selected from pyrrolidinyl, pyrimidinyl, morpholino, piperidinyl, piperazinyl, and thiomorpholino,
wherein the heterocycle is optionally substituted with one or more substituents independently selected from methyl, spirocyclopropyl, CH2)H, CH2CF3, NH2, NH, oxo, thiophene, and phenyl optionally substituted with F or CF3.

### Claim 8 (depends on 7)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 7, wherein Ra and Rb together with the N to which they are attached form a morpholino group or a piperazinyl group, wherein the morpholino group or piperazinyl group is substituted with phenyl, fluoro-phenyl, difluoro-phenyl, or thiophenyl,
and wherein the morpholino group or piperazinyl group is optionally further substituted with methyl, CH2OH, or spiro-cyclopropyl.

### Claim 9 (depends on 7, 8)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 7 or 8, wherein Ra and Rb together with the N to which they are attached form a piperazinyl group substituted with phenyl, fluoro-phenyl, or difluoro-phenyl, and wherein the piperazinyl group is optionally further substituted with methyl.

### Claim 10 (depends on 7, 8)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 7 or 8, wherein Ra and Rb together with the N to which they are attached form a piperidinyl group substituted with phenyl, fluoro-phenyl, or difluoro-phenyl, and wherein the piperidinyl group is further substituted with NH2, optionally NH2 at position 4.

### Claim 11 (depends on 6)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 6, wherein R1 is NRaCH2Rb, wherein Ra is H or methyl and Rb is selected from cyclobutyl optionally substituted with F, cyclohexyl, phenyl optionally substituted with F, furan and thiophene, optionally wherein the methylene group is substituted with CF3.

### Claim 12 (depends on 11)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 11, wherein Rb is phenyl or fluoro-substituted phenyl.

### Claim 13 (depends on 1, 2, 3)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1-3, wherein R1 is ORa or OCH2Ra, wherein Ra is selected from H, optionally substituted C1-C6 alkyl, CF3, or optionally substituted cyclopropyl, optionally substituted cyclobutyl, optionally substituted cyclopentyl, optionally substituted cyclohexyl, optionally substituted phenyl, optionally substituted benzyl, optionally substituted pyridinyl, optionally substituted pyrazole, optionally substituted imidazole.

### Claim 14 (depends on 13)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 13, wherein each optional substituent is independently selected from NO2, methyl, OH or CF3.

### Claim 15 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1-14, wherein R2 and R3 are independently selected from H, methyl and ethyl, or together form optionally substituted cyclopropyl, optionally substituted cyclobutyl, optionally substituted cyclopentyl, optionally substituted cyclohexyl, optionally substituted pyrrolidine, optionally substituted tetrahydropyran or optionally substituted tetrahydrofuran together with the carbon to which they attached.

### Claim 16 (depends on 15)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 15, wherein R2 and R3 are independently selected from H, and methyl.

### Claim 17 (depends on 16)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 16, wherein R2 and R3 together form cyclohexyl, cyclopentyl or cyclobutyl together with the carbon to which they attached, preferably cyclopentyl.

### Claim 18 (depends on 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1 and 3-17, wherein:
X is CR4a, wherein R4a is as defined in claim 1, optionally H or C1-C6 alkyl;
Y is N;
Z is CR7, wherein R7 is as defined in claim 1;
M is CH or C—CH3;
the ring including X, Y and Z is aromatic, and A, D, E and G are all absent.

### Claim 19 (depends on 18)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 18, wherein Z is CR7 and R7 is selected from H, phenyl, pyridine, pyrazole, indazole, imidazole, Cl, Br, COOH, COOCH3, CONRcRd, NRcRd
wherein RcRd are each methyl, or wherein Rc and Rd together form an optionally substituted piperazine, optionally substituted morpholine, or optionally substituted pyrrolidine together with the N to which they are attached.

### Claim 20 (depends on 19)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 19, wherein R7 is Cl, Br or C(O)OCH3, or wherein R7 is CONRcRd and Rc and Rd are each methyl, or wherein Rc and Rd form a piperazinyl ring together with the N to which they are attached.

### Claim 21 (depends on 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1 and 3-17, wherein:
X is CR4a, wherein R42 is as defined in claim 1, optionally H or C1-C6 alkyl;
Y is CR5;
Z is N or CR7;
M is CH or C—CH3;
wherein R5 and R7 is as defined in claim 1, the ring including X, Y and Z is aromatic, and A, D, E and G are all absent.

### Claim 22 (depends on 21)

The compound stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 21, wherein:
X is CH
Z is N or CH
M is CH
Y is CR5 wherein R5 is selected from optionally substituted C3-C6 cycloalkyl, optionally substituted C3-C6 heterocycloalkyl, optionally substituted C5-C8 aryl, optionally substituted C3-C8 heteroaryl, and NR′R″, wherein R′ and R″ together form an optionally substituted C3-C6 heterocycloalkyl including the nitrogen to which they are attached.

### Claim 23 (depends on 21, 22)

The compound stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 21 or 22, wherein
R5 is selected from optionally substituted cyclopropyl, optionally substituted phenyl, optionally substituted thiophenyl, optionally substituted piperidinyl, optionally substituted pyrazolyl, optionally substituted pyridinyl, optionally substituted pyrrolidinyl, optionally substituted dihydrobenzofuranyl, optionally substituted azabicyclohexyl, and optionally substituted azetidinyl.

### Claim 24 (depends on 21, 22, 23)

The compound stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 21-23, wherein each one or more optional substituents of R5 is selected from the group consisting of: Cl, F, methyl, CHF2, CF3, methoxy, OCHF2, OCF3, cyclopropyl, and cyclopropyloxy.

### Claim 25 (depends on 21)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 21, wherein R4a is H, R5 is Cl or phenyl optionally substituted with fluoro, and Z is N or CR7.

### Claim 26 (depends on 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1 and 3-17, wherein the ring including X, Y and Z is aliphatic, wherein A, D, E and G are all absent and wherein:
X is absent, CR4aR4b, NR4a, or C═O
Y is O, CR5R6, or NR5
Z is CR7R8, wherein R7 and R8 are independently selected from H, halo, C1-C6 alkyl, C2-C6 alkene, C2-C6 alkyne, C3-C6 cycloalkyl, optionally substituted C3-C6 heterocycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C3-C8 heteroaryl, CN, COORc, CONRcRd, NRcRd, wherein Rc and Rd are independently selected from H, C1-C6 alkyl, and C3-C6 cycloalkyl, or Rc and Rd together form an optionally substituted C3-C7 heterocycle together with the heteroatom to which they are attached,
or wherein R7 and R8 together form a C3-6 cycloalkyl or C3-C6 heterocycloalkyl including the carbon to which they are attached;
M is absent, CH2, or Z and M together form part of an optionally substituted phenyl or pyridine ring;
or M is absent and Y and Z together form part of a fused phenyl or heteroaryl ring,
or M and X are both absent and Z is CHR7
wherein R4a, R4b, R5, and R6 are as defined in claim 1.

### Claim 27 (depends on 26)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 26, wherein:
X is CR4aR4b, wherein R4a is selected from H or C1-C6 alkyl, and R4b is H;
Y is O or CR5R6, wherein R5 and R6 are independently selected from H, halo, optionally substituted C1-C6 alkyl, optionally substituted phenyl, benzyl, pyridinyl, CH2OH, C(O)R′, COR′, C(O)OR′, C(O)NR′R″, and SO2R′, wherein R′ and R″ are independently selected from methyl, ethyl, propyl, butyl, phenyl, and benzyl, or wherein R5 and R5 together form cyclohexyl, including the carbon to which they are attached;
and Z is CR7R8, wherein R7 is selected from H, C1-C6 alkyl, phenyl, and C(O)NRcRd, wherein Rc and Rd are independently H, methyl or Rc and Rd together form an optionally substituted pyrrolidine together with the nitrogen to which they are attached, and wherein R8 is H.

### Claim 28 (depends on 27)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 27, wherein:
R4a and R4b are both H;
Y is O or CR5R6, wherein R5 is phenyl or C(O)NR′R″, wherein R′ and R″ are both methyl, and R6 is H; and
Z is CR7R8, wherein R7 is phenyl or C(O)NRcRd, wherein Rc and Rd are both methyl.

### Claim 29 (depends on 26)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 26, wherein Z is CH2 and Y is NR5, wherein R5 is phenyl, pyridinyl, butyl carboxylate or C(O)CH3, preferably wherein R5 is phenyl.

### Claim 30 (depends on 1)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1, and 3-17, wherein the ring including X, Y and Z is aliphatic, and wherein:
A, D, E and G are each C or N and form a fused aryl or heteroaryl ring with the aliphatic ring including X, Y and Z
X is C
Y is C
Z is NR′, CR7R8 or C═O
M is absent or CR13R14, wherein R13 and R14 are independently selected from H, and C1-C6 alkyl, or wherein R13 and R14 together form a C3-C6 cycloalkyl together with the carbon to which they are attached; and
wherein R7 and R8 are as defined in claim 1.

### Claim 31 (depends on 30)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 30, wherein M is absent and Z is CR7R8 wherein R7 and R8 are H.

### Claim 32 (depends on 31)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 31, wherein A, D and E are C, and G is C or N.

### Claim 33 (depends on 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1 and 3-17, wherein:
X is C or N
Y is C or N
Z is N, NR7, or CR7, wherein R7 is as defined in claim 1,
M is absent, CH or C—CH3,
A is CR9, CHR9, N, NR9, S or O,
D is CR9, CHR9, N or NR9,
G is absent, CR9, CHR9, or N,
wherein R9 is independently selected from H, halo, C1-C6 alkyl, CF3, and OR*, wherein R* is selected from optionally substituted C1-C6 alkyl, optionally substituted C3-C6 cycloalkyl, and optionally substituted C3-C6 heterocycloalkyl,
E is CR10, CHR10, N, NR10, S, or O,
wherein R10 is selected from H, halo, C1-C6 alkyl, C3-C6 cycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C4-C8 heteroaryl, SRx, ORx, NRxRy, and NS(O)(Rx)Ry, S(O)(Rx)NRy
wherein Rx and Ry are independently selected from H, C1-C6 alkyl, CF3, C3-C6 cycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C4-C8 heteroaryl, COOH, amido, cyano, C2-C6 alkene, C2-C6 alkyne, or wherein Rx and Ry together form an optionally substituted C4-C6 heterocycloalkyl together with the nitrogen to which they are attached.

### Claim 34 (depends on 33)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 33, wherein
Z is N, or CR7, wherein R7 is selected from H, C1-C6 alkyl, CN or C(O)NRcRd, wherein Rc and Rd are independently H, methyl, or together form an optionally substituted piperidine, piperazine or morpholine ring together with the nitrogen to which they are attached.

### Claim 35 (depends on 33, 34)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of claim 33 or 34, wherein:
E is CR10, CHR10, N, NR10, S, or O,
wherein R10 is selected from H, F, Cl, Br, methyl, ethyl, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, SRx, ORx, NRxRy, and NS(O)(CH3)2, wherein Rx and Ry are independently selected from H, methyl. ethyl, CF3, cyclopropyl, cyclobutyl, cyclopentyl, cyclohexyl, COOH, amido, cyano, or wherein Rx and Ry together form a piperidine, piperazine or morpholine together with the nitrogen to which they are attached, optionally substituted with methyl.

### Claim 36 (depends on 33, 34, 35)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 33-35, wherein:
A, M, X and Y are C, E is CR10,
D is N,
G is C or N, and
Z is C or N,
such that the rings including A, D, E, G, X, Y, Z and M form a fused aromatic ring system.

### Claim 37 (depends on 32)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 32, wherein:
M is absent,
A, X and Y are C, D and G are N, E is CR10, and Z is NR7, such that the ring including A, D, E, G, X, and Y, forms an aromatic ring fused to the ring including X, Y and Z,
wherein R7 is H or C1-C6 alkyl, optionally wherein R7 is methyl.

### Claim 38 (depends on 33, 34, 35, 36, 37)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 33-37, wherein E is CR10 wherein R10 is H or SRx, wherein Rx is C1-C6 alkyl, preferably wherein Rx is methyl.

### Claim 39 (depends on 33)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 33, wherein:
X, Y, M, A and G are C, Z is N, D is CR9 and E is CR10, such that the rings including A, D, E, G, X, Y, Z and M form a fused aromatic ring system,
wherein R9 is halo, preferably F or Cl, and R10 is H or halo, optionally F or Cl.

### Claim 40 (depends on 33)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 33, wherein:
G is absent, A is C, D and Z are N, and E is NR10, such that the rings including A, D, E, X, Y, Z and M form a fused aromatic ring system, wherein R10 is selected from H, ethyl, phenyl and benzyl.

### Claim 41 (depends on 1, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt of any one of claims 1 or 3-17, wherein:
X is CR4a, wherein R4a is as defined in claim 1;
Y is CR5, wherein R5 is selected from H, halo, C1-C6 alkyl, C3-C6 cycloalkyl, optionally halo-substituted phenyl, optionally halo-substituted benzyl, pyridinyl, pyrazole, imidazole, CH2OH, NR′R″, COR′, C(O)OR′, C(O)NR′R″, OR′, wherein R′ and R″ are independently selected from C1-C6 alkyl, and phenyl, benzyl, pyridinyl, pyrazole, imidazole;
Z is CR7, wherein R7 is as defined in claim 1;
M is CH;
the ring including X, Y and Z is aromatic, and A, D, E and G are all absent.

### Claim 42 (depends on 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 2-17, wherein the compound is according to formula (Ia)
wherein the ring including QXYZM is aliphatic;
wherein Q is CHR11, where R11 is selected from H, OH, C1-C6 alkyl, CF3, C3-C6 cycloalkyl, C5-C8 aryl, or C4-C8 heteroaryl;
X is CHR4a, wherein R4a is selected from H, C1-C6 alkyl or halo, preferably wherein R4a is methyl;
Y is CR5R6 wherein R5 and R6 are independently selected from H, halo, C1-C6 alkyl, C3-C6 cycloalkyl, C5-C8 aryl, C3-C8 heteroaryl, CH2OH, NR′R″, and OR′, wherein R′ and R″ are independently selected from H and C1-C6 alkyl; preferably wherein Y is CH2
Z is CR7R8, wherein R7 and R8 are independently selected from H, halo, C1-C6 alkyl, C2-C6 alkene, C2-C6 alkyne, C3-C6 cycloalkyl, optionally substituted C3-C6 heterocycloalkyl, C5-C8 aryl, C6-C9 arylalkyl, C3-C8 heteroaryl, CN, COORc, CONRcRd, NRcRd, NS(O)RcRd, S(O)(Rc)NRd, SORc, SO2Rc, and SRc, wherein Rc and Rd are independently H, C1-C6 alkyl, C3-C6 cycloalkyl, C5-C6 aryl, C6-C9 arylalkyl, C3-C6 heteroaryl, CN, COOH, or COCH3 or Rc and Rd together form an optionally substituted C3-C7 heterocycle together with the heteroatom to which they are attached,
or wherein R7 and R8 together form a C3-6 cycloalkyl or C3-C6 heterocycloalkyl including the carbon to which they are attached; and
M is CR13R14, wherein R13 and R14 are independently selected from H, and C1-C6 alkyl, or wherein R13 and R14 together form a C3-C6 cycloalkyl together with the carbon to which they are attached; preferably wherein M is CH2 or CHCH3.

### Claim 43 (depends on 42)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to claim 42, wherein the ring including QXYZM is aliphatic, Q is CH2, X is CHCH3, Y is CH2, Z is CHCH3 and M is CH2.

### Claim 44 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 21, 25, 26, 30, 33, 41, 42)

The compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-18, 21, 25, 26, 30, 33, 41 and 42 wherein:
Z is CR7 or CHR7 and R7 is selected from NS(O)RcRd, S(O)(Rc)NRd, SO2Rc, and SRc, wherein Rc is selected from H, methyl;
and wherein Rd is selected from H, C1-C6 alkyl, C5-C6 aryl, C6-C9 arylalkyl, C3-C6 heteroaryl, CN, COOH, or COCH3.

### Claim 45

A compound according to formula (I) selected from:
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-phenylpyrazin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
1-((7-((R)-3-Cyclobutyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
1-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
5-Chloro-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
5-Bromo-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
Methyl 4-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-oxo-4,5-dihydropyrazine-2-carboxylate
4-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-oxo-4,5-dihydropyrazine-2-carboxylic acid
4-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-N,N-dimethyl-5-oxo-4,5-dihydropyrazine-2-carboxamide
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(piperazine-1-carbonyl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(pyridin-3-yl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(2-oxopyrrolidin-1-yl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(pyridin-4-yl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(1H-indazol-1-yl)pyrazin-2(1H)-one and 1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(2H-indazol-2-yl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(1H-pyrazol-5-yl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(1H-pyrazol-1-yl)pyrazin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(pyridin-3-yl)pyrazin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(pyridin-4-yl)pyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-methylpyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-cyclopropylpyrazin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(pyridin-2-yl)pyrazin-2(1H)-one
(R)-4-(2-Fluorophenyl)-1-((4-hydroxy-1-(3-phenylbutanoyl)piperidin-4-yl)methyl)piperazin-2-one
1-(((R)-1-((S)-3-Cyclohexyl-2-(hydroxymethyl)propanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-N,N-dimethyl-6-oxo-4-phenylpiperidine-3-carboxamide and 1-(((S)-1-((S)-3-Cyclohexyl-2-(hydroxymethyl)propanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-N,N-dimethyl-6-oxo-4-phenylpiperidine-3-carboxamide
2-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)isoindolin-1-one
4S)-1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-4-phenylpyrrolidin-2-one
(4R)-1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-4-phenylpyrrolidin-2-one
4-Benzyl-1-((1-((R)-3-cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)pyrrolidin-2-one
4-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)morpholin-3-one
4-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)morpholin-3-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-3-propyl-1,3-dihydro-2H-benzo[d]imidazol-2-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-(hydroxymethyl) pyrrolidin-2-one
4-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2H-pyrido[3,2-b][1,4]oxazin-3(4H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)indoline-2,3-dione
8-Amino-4-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2H-benzo[b][1,4]oxazin-3(4H)-one
tert-Butyl 4-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-3-oxopiperazine-1-carboxylate
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)piperazin-2-one
(4S)-1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyrrolidin-2-one
4-Benzyl-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrrolidin-2-one
2-((1-(3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)isoindoline-1,3-dione
4-Benzyl-1-((1-(3-cyclohexyl-2-methylpropanoyl)-4-hydroxypiperidin-4-yl)methyl)pyrrolidin-2-one
4-Benzyl-1-((4-hydroxy-3,3-dimethyl-1-(2-methyl-3-phenylpropanoyl)piperidin-4-yl)methyl)pyrrolidin-2-one
4-Benzyl-1-((1-(3-cyclohexylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)pyrrolidin-2-one
2-((1-(3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-2-azaspiro[4.5]decan-3-one
Benzyl 4-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-3-oxopiperazine-1-carboxylate
4-Acetyl-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)piperazin-2-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-(methylsulfonyl)piperazin-2-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpiperazin-2-one
2-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-[1,2,4]triazolo[4,3-a]pyridin-3(2H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6,7-dimethoxyquinazolin-4(3H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-3,7-dihydro-4H-pyrrolo[2,3-d]pyrimidin-4-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-1-methyl-6-(methylthio)-1,2-dihydro-3H-pyrazolo[3,4-d]pyrimidin-3-one
6-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2-(methylthio)pyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-(methylthio)pyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-(methylamino)pyrido[4,3-d]pyrimidin-5(6H)-one
2-(Dimethylamino)-6-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-methoxypyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-morpholinopyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-(4-methylpiperazin-1-yl)pyrido[4,3-d]pyrimidin-5(6H)-one
2-((Dimethyl(oxo)-λ6-sulfaneylidene)amino)-6-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-(piperazin-1-yl)pyrido[4,3-d]pyrimidin-5(6H)-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1-methyl-6-(methylthio)-1,2-dihydro-3H-pyrazolo[3,4-d]pyrimidin-3-one
1-(((R)-1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-((dimethyl(oxo)-λ6-sulfaneylidene)amino)-4-(2-fluorophenyl)pyridin-2(1H)-one and 1-(((S)-1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-((dimethyl(oxo)-λ6-sulfaneylidene)amino)-4-(2-fluorophenyl)pyridin-2(1H)-one
4-Chloro-1-((1-((R)-3-cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(S-methylsulfonimidoyl)pyridin-2(1H)-one
1-((1-((R)-3-Cyclohexyl-2-methylpropanoyl)-4-hydroxy-3,3-dimethylpiperidin-4-yl)methyl)-5-(S-methylsulfonimidoyl)-4-phenylpyridin-2(1H)-one
4-Chloro-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-((dimethyl(oxo)-λ6-sulfaneylidene)amino)pyridin-2(1H)-one
4-Chloro-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(S-methylsulfonimidoyl)pyridin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-((dimethyl(oxo)-λ6-sulfaneylidene)amino)-4-phenylpyridin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-((dimethyl(oxo)-λ6-sulfaneylidene)amino)-5-phenylpyridin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(S-methylsulfonimidoyl)-4-phenylpyridin-2(1H)-one
5-((Dimethyl(oxo)-λ6-sulfaneylidene)amino)-1-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyridin-2(1H)-one
4-Chloro-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylthio)pyridin-2(1H)-one
4-Chloro-1-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylsulfonyl)pyridin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylthio)-4-phenylpyridin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylsulfinyl)-4-phenylpyridin-2(1H)-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylsulfonyl)-4-phenylpyridin-2(1H)-one
N-Benzyl-4-((4-(2-fluorophenyl)-6-oxopyrimidin-1(6H)-yl)methyl)-4-hydroxy-N-methylpiperidine-1-carboxamide
N-(Cyclohexylmethyl)-10-((5-(dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-10-hydroxy-N-methyl-7-azaspiro[4.5]decane-7-carboxamide
4-Nitrophenyl 10-((5-(dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-10-hydroxy-7-azaspiro[4.5]decane-7-carboxylate
Isobutyl 10-((5-(dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-10-hydroxy-7-azaspiro[4.5]decane-7-carboxylate
N-Benzyl-10-((5-(dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1 (2H)-yl)methyl)-10-hydroxy-7-azaspiro[4.5]decane-7-carboxamide
10-((5-(Dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-10-hydroxy-N,N-dimethyl-7-50 azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-((5-(dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1 (2H)-yl)methyl)-10-hydroxy-N-methyl-7-azaspiro[4.5]decane-7-carboxamide
1-((10-Hydroxy-7-(3-(trifluoromethyl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-N,N-dimethyl-6-oxo-4-phenyl-1,6-dihydropyridine-3-carboxamide
N-Cyclohexyl-10-((5-(dimethylcarbamoyl)-2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-10-hydroxy-N-methyl-7-azaspiro[4.5]decane-7-carboxamide
1-((10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrazin-2(1H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-methylpyrazin-2(1H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-3-methylpyrazin-2(1H)-one
(6R)-4-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-methylmorpholin-3-one
6-Cyclopropyl-4-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)morpholin-3-one
4-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7-oxa-4-azaspiro[2.5]octan-5-one
4-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-methylmorpholin-3-one
1-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-(methoxymethyl) piperidin-2-one
1-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4,6-dimethylazepan-2-one
4-Ethyl-1-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)piperidin-2-one
1-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylazetidin-2-one
6-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-5,6-dihydro-7H-pyrrolo[3,4-b]pyridin-7-one
6-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6,7-dihydro-5H-pyrrolo[3,4-b]pyridin-5-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6,7-dihydro-5H-pyrrolo[3,4-b]pyridin-5-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)isoindolin-1-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2,3-dihydro-1H-pyrrolo[3,4-c]pyridin-1-one
10-((4-Benzoyl-2-oxopiperazin-1-yl)methyl)-N-benzyl-10-hydroxy-7-azaspiro[4.5]decane-7-carboxamide
4-Benzoyl-1-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)piperazin-2-one
N-Benzyl-10-hydroxy-10-((2-oxo-4-phenylpiperazin-1-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
1-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpiperazin-2-one
10-((4-Acetyl-2-oxopiperazin-1-yl)methyl)-N-benzyl-10-hydroxy-7-azaspiro[4.5]decane-7-carboxamide
4-Acetyl-1-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)piperazin-2-one
1-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-(pyridin-2-yl)piperazin-2-one
1-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-methylpiperazin-2-one
N-Benzyl-10-((4-(4,4-dimethylcyclohexyl)-2-oxopiperazin-1-yl)methyl)-10-hydroxy-7-azaspiro[4.5]decane-7-carboxamide
4-(4,4-Dimethylcyclohexyl)-1-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)piperazin-2-one
4-((10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)morpholin-3-one]
4-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)morpholin-3-one
7-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7,8-50 dihydroimidazo[1,2-a]pyrazin-6(5H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2-methylquinazolin-4(3H)-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-7-fluoroisoquinolin-1 (2H)-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7-methoxyisoquinolin-1(2H)-one
3-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)thieno[2,3-d]pyrimidin-4(3H)-one
5-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-1-ethyl-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-8-methylquinazolin-4(3H)-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(trifluoromethyl)isoquinolin-1(2H)-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-7-methoxyisoquinolin-1 (2H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
7-Chloro-3-((7-((R)-3-cyclo hexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-N,N-dimethyl-1-oxo-1,2-dihydroisoquinoline-4-carboxamide
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-8-fluoroquinazolin-4(3H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)thieno[2,3-d]pyrimidin-4(3H)-one
3-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7-methoxyquinazolin-4(3H)-one
7-Chloro-3-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
7-Fluoro-2-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)isoquinolin-1 (2H)-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2,7-naphthyridin-1(2H)-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2,7-naphthyridin-1(2H)-one
5-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)furo[3,2-c]pyridin-4(5H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-7-methoxyquinazolin-4(3H)-one
2-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6,7-dimethoxyisoquinolin-1(2H)-one
1-Ethyl-5-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
5-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)thieno[3,2-c]pyridin-4(5H)-one
6-Chloro-3-((7-((R)-3-cyclo hexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)thieno[3,2-d]pyrimidin-4(3H)-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-N,N-dimethyl-1-oxo-1,2-dihydroisoquinoline-4-carboxamide
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6,7-dimethoxyisoquinolin-1(2H)-one
6-Chloro-3-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
6-Fluoro-3-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
6-Chloro-7-fluoro-3-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
6-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrido[3,4-b]pyrazin-5(6H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6,7-difluoroquinazolin-4(3H)-one
5-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2-ethyl-2,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2-methylpyrido[3,4-d]pyrimidin-4(3H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-fluoroquinazolin-4(3H)-one
6-Chloro-3-((7-((R)-3-cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-7-fluoroquinazolin-4(3H)-one
7-Fluoro-3-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrido[4,3-d]pyrimidin-4(3H)-one
6-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrido[4,3-d]pyrimidin-5(6H)-one
6-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrido[4,3-d]pyrimidin-5(6H)-one
3-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-7-(methylthio)pyrimido[4,5-d]pyrimidin-4(3H)-one
3-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7-(methylthio)pyrimido[4,5-d]pyrimidin-4(3H)-one
3-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7-morpholinopyrimido[4,5-d]pyrimidin-4(3H)-one
3-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-7-(4-methylpiperazin-1-yl)pyrimido[4,5-d]pyrimidin-4(3H)-one
6-Fluoro-3-((10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
6,7-Difluoro-3-((10-hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
2-((10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2,7-naphthyridin-1(2H)-one
1-Benzyl-5-((10-hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
1-Benzyl-5-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
6-Fluoro-3-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
6,7-Difluoro-3-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)quinazolin-4(3H)-one
2-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2,7-naphthyridin-1(2H)-one
1-Benzyl-5-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
6-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-2-methyl-2,6-dihydro-7H-pyrazolo[4,3-d]pyrimidin-7-one
2-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-1-methyl-1,2-dihydro-3H-pyrazolo[3,4-d]pyrimidin-3-one
2-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1-methyl-1,2-dihydro-3H-pyrazolo[3,4-d]pyrimidin-3-one
5-((7-((R)-3-Cyclohexyl-2-methylpropanoyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-1-phenyl-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
5-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1-phenyl-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
5-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1-phenyl-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
6-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-methyl-2,6-dihydro-7H-pyrazolo[4,3-d]pyrimidin-7-one
5-((10-Hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1-methyl-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
1-Cyclopropyl-5-((10-hydroxy-7-((R)-4,4,4-trifluoro-2-methylbutanoyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
5-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1-methyl-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
1-Cyclopropyl-5-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-1,5-dihydro-4H-pyrazolo[3,4-d]pyrimidin-4-one
6-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-2-(methylthio)pyrido[4,3-d]pyrimidin-5(6H)-one
6-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-50 yl)methyl)pyrido[4,3-d]pyrimidin-5(6H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylthio)-4-phenylpyridin-2(1H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylsulfinyl)-4-phenylpyridin-2(1H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-(methylsulfonyl)-4-phenylpyridin-2(1H)-one
1-((10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-(S-methylsulfonimidoyl)-4-phenylpyridin-2(1H)-one
1-((10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-(S-methylsulfonimidoyl)-4-phenylpyridin-2(1H)-one
5-((Dimethyl(oxo)-λ6-sulfaneylidene)amino)-1-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyridin-2(1H)-one
N-Benzyl-10-hydroxy-10-((2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-8-((4-(2-fluorophenyl)-6-oxopyrimidin-1(6H)-yl)methyl)-8-hydroxy-5-azaspiro[2.5]octane-5-carboxamide
N-Benzyl-4-((4-(2-fluorophenyl)-6-oxopyrimidin-1(6H)-yl)methyl)-4-hydroxy-3,3-dimethylpiperidine-1-carboxamide
10-Hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-N-(2,2,2-trifluoroethyl)-7-azaspiro[4.5]decane-7-carboxamide
10-Hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-N-(pyridin-2-ylmethyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-((4-chloro-6-oxopyrimidin-1(6H)-yl)methyl)-10-hydroxy-7-azaspiro[4.5]decane-7-carboxamide
10-Hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H-yl)methyl)-N-(pyridin-3-ylmethyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((6-oxo-4-(pyridin-3-yl)pyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((6-oxo-4-(pyridin-4-yl)pyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((6-oxo-4-(pyrrolidin-1-yl)pyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((4-morpholino-6-oxopyrimidin-1 (6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((4-(1-methyl-1H-pyrazol-4-yl)-6-oxopyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-Benzyl-10-hydroxy-10-((4-(1-methyl-1H-pyrazol-5-yl)-6-oxopyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((10-Hydroxy-7-(2-(trifluoromethyl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-((R)-2-methylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-isopropylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(3-Azabicyclo[3.1.0]hexane-3-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((S)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((S)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((S)-2-phenylpyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(S)-10-Hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-N-(thiophen-2-ylmethyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(4-Cyanobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(3-Fluorobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(Benzo[d][1,3]dioxol-5-ylmethyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-((5-Cyclopropyl-1,2,4-oxadiazol-3-yl)methyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-50 yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(Furan-2-ylmethyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
6-Chloro-3-(((S)-10-hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
(S)-3-((10-Hydroxy-7-(3-(trifluoromethyl)azetidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
6-Cyclopropyl-3-(((S)-10-hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(pyrrolidin-1-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-5-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-4-yl)pyrimidin-4(3H)-one
6-(Dimethylamino)-3-(((S)-10-hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((10S)-10-Hydroxy-7-(3-(trifluoromethyl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((R)-3-(4-Fluorophenyl)morpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(3-(Cyclopropylmethyl)morpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(3-Cyclobutylmorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(3-(methoxymethyl)morpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
N-(Furan-3-ylmethyl)-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((10-Hydroxy-7-(2-methylpyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
N-Cyclobutyl-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((10-Hydroxy-7-(3-(thiophen-2-yl)morpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(6-oxa-1-azaspiro[3.4]octane-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(3-Cyclopropylpyrrolidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
10-Hydroxy-N-(isothiazol-5-ylmethyl)-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-((3-Fluorocyclobutyl)methyl)-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((7-(2,2-Dimethylpyrrolidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(4-(Difluoromethyl)piperidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
N-(Furan-2-ylmethyl)-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((7-(2-Oxa-5-azabicyclo[4.1.0]heptane-5-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
10-Hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-N-(pyridin-3-ylmethyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((10-Hydroxy-7-(2-(pyridin-3-yl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(3-(1H-Pyrrol-1-yl)pyrrolidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
N-(1-Cyclopropylethyl)-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((7-(3-Cyclopropylmorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-(pyridin-4-yl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(5-azaspiro[2.5]octane-5-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
N-(3-Cyanobenzyl)-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((7-(3-Cyclopropylazetidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(2,2-Difluoromorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
N-(2-Fluorobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-(1-(Furan-3-yl)ethyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
10-Hydroxy-N-((1-methylcyclopropyl)methyl)-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-(3-Cyanobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-(4-(Cyanomethyl)benzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-((5,6-Dihydro-2H-pyran-3-yl)methyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
N-((1,3-Dihydroisobenzofuran-5-yl)methyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((10-Hydroxy-7-(4-oxa-1-azaspiro[5.5]undecane-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(3-(Difluoromethyl)pyrrolidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(3-(trifluoromethyl)morpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(2-Cyclopropylpyrrolidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-((S)-2-(isoxazol-3-yl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(2S)-1-(10-Hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carbonyl)-N,N-dimethylpyrrolidine-2-carboxamide
3-((10-Hydroxy-7-((S)-2-(thiophen-2-ylmethyl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-((S)-2-(1H-1,2,4-Triazol-5-yl)pyrrolidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-((S)-2-(5-methyl-1H-1,2,4-triazol-3-yl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-((S)-2-(4-isopropyloxazol-2-yl)pyrrolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-(2-methoxyphenyl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-(3-methoxyphenyl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-(4-methoxyphenyl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-(pyridin-3-yl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(2-Cyclopropylpiperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((7-(2-Cyclobutylpiperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((10-Hydroxy-7-(2-(methoxymethyl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((R)-4-Acetyl-2-phenylpiperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
2-((10-Hydroxy-7-((R)-3-phenylmorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-5-phenylpyridazin-3(2H)-one
3-(((S)-10-Hydroxy-7-((R)-4-methyl-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
6-Chloro-3-(((S)-7-((R)-3-(4-fluorophenyl)morpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
1-(((S)-4-Hydroxy-3,3-dimethyl-1-((R)-3-phenylmorpholine-4-carbonyl)piperidin-4-yl)methyl)-N,N-dimethyl-6-oxo-4-phenyl-1,6-dihydropyridine-3-carboxamide
3-(((S)-7-((R)-3-(4-Fluorophenyl)morpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-5-yl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-3-(4-Fluorophenyl)morpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-4-yl)pyrimidin-4(3H)-one
1-(((S)-4-Hydroxy-3,3-dimethyl-1-((R)-3-phenylmorpholine-4-carbonyl)piperidin-4-yl)methyl)-4-phenylpyridin-2(1H)-one
1-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyridin-2(1H)-one
1-(((S)-4-Hydroxy-3,3-dimethyl-1-((R)-2-phenylpiperazine-1-carbonyl)piperidin-4-yl)methyl)-4-phenylpyridin-2(1H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-5-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(pyrrolidin-1-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-4-yl)pyrimidin-4(3H)-one
6-Cyclopropyl-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-3-(1H-Benzo[d]imidazol-2-yl)morpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(S)-10-Hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-N—((R)-2,2,2-trifluoro-1-phenylethyl)-7-azaspiro[4.5]decane-7-carboxamide
(R)-3-((4-Hydroxy-1-(3-phenylmorpholine-4-carbonyl)piperidin-4-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((5-Hydroxy-2-((R)-3-phenylmorpholine-4-carbonyl)-2-azaspiro[5.5]undecan-5-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(R)-3-((4-Hydroxy-1-(2-phenylpiperazine-1-carbonyl)piperidin-4-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((5-Hydroxy-2-((R)-2-phenylpiperazine-1-carbonyl)-2-azaspiro[5.5]undecan-5-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(S)-3-((10-Hydroxy-7-(2-phenylpyrazolidine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-methylpyrimidin-4(3H)-one
(S)—N-(2,3-Difluorobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(2,6-Difluorobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(2,4-Difluorobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(3,4-Difluorobenzyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1 (6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
3-((9-Hydroxy-6-((R)-3-phenylmorpholine-4-carbonyl)-6-azaspiro[3.5]nonan-9-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((9-Hydroxy-6-((R)-2-phenylpiperazine-1-carbonyl)-6-azaspiro[3.5]nonan-9-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(S)—N-((3,3-Difluorocyclobutyl)methyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(1,1,1,3,3,3-Hexafluoropropan-2-yl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)-10-Hydroxy-10-((2-oxo-4-phenylpyridin-1(2H)-yl)methyl)-N—((R)-2,2,2-trifluoro-1-phenylethyl)-7-azaspiro[4.5]decane-7-carboxamide
3-(((S)-4-Hydroxy-3,3-dimethyl-1-((R)-3-phenylmorpholine-4-carbonyl)piperidin-4-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(S)—N-((1-Fluorocyclopropyl)methyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-((1-Fluorocyclobutyl)methyl)-10-hydroxy-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
(S)—N-(Cyclopropylmethyl)-10-hydroxy-N-methyl-10-((6-oxo-4-phenylpyrimidin-1(6H)-yl)methyl)-7-azaspiro[4.5]decane-7-carboxamide
6-(2-Fluorophenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(3-Fluorophenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(4-Fluoro phenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-methoxyphenyl)pyrimidin-4(3H)-one
6-(Dimethylamino)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(methylamino)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(3-Fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-((5-Hydroxy-2-((R)-2-phenylpiperazine-1-carbonyl)-9-oxa-2-azaspiro[5.5]undecan-5-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-4-Hydroxy-3,3-dimethyl-1-((R)-2-phenylpiperazine-1-carbonyl)piperidin-4-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenyl-4-(2,2,2-trifluoroethyl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-methoxypyrimidin-4(3H)-one
3-((5-Hydroxy-2-((R)-3-phenylmorpholine-4-carbonyl)-9-oxa-2-azaspiro[5.5]undecan-5-yl)methyl)-6-phenylpyrimidin-4(3H)-one
4-Chloro-1-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyridin-2(1H)-one
4-Cyclopropyl-1-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyridin-2(1H)-one
1-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-(1-methyl-1H-pyrazol-5-yl)pyridin-2(1H)-one
1-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-(1-methyl-1H-pyrazol-4-yl)pyridin-2(1H)-one
1-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-(pyrrolidin-1-yl)pyridin-2(1H)-one
5-Fluoro-1-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyridin-2(1H)-one
3-Fluoro-1-((10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyridin-2(1H)-one
(S)-3-((10-Hydroxy-7-(3-phenylthiomorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((10S)-10-Hydroxy-7-(1-imino-1-oxido-3-phenyl-1λ6-thiomorpholine-4-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
(S)-3-((7-(1,1-Dioxido-3-phenylthiomorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one, and
3-(((10S)-10-Hydroxy-7-(2-(4-(trifluoromethyl)phenyl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one,
3-(((10S)-10-Hydroxy-7-(2-(thiophen-3-yl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(3-methoxyphenyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(4-methoxyphenyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(o-tolyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(m-tolyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(p-tolyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(thiophen-2-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(thiophen-3-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(5-methoxythiophen-2-yl)pyrimidin-4(3H)-one
6-(2,3-Dihydrobenzofuran-5-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(1,3-Dihydroisobenzofuran-5-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(piperidin-1-yl)pyrimidin-4(3H)-one
6-(4-Chlorophenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(4-Cyclopropoxyphenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(4,4-Difluoropiperidin-1-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(3-Azabicyclo[3.1.0]hexan-3-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(2,3-Dihydrobenzofuran-6-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-(trifluoromethoxy)phenyl)pyrimidin-4(3H)-one
6-(2-Fluorophenyl)-3-(((S)-7-((R)-2-(3-fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(3-Fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-methoxyphenyl)pyrimidin-4(3H)-one
6-(3,3-Difluoroazetidin-1-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((10S)-10-Hydroxy-7-(2-(thiophen-2-yl)piperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
6-(3,3-Difluoropyrrolidin-1-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-(trifluoromethyl)phenyl)pyrimidin-4(3H)-one
6-(4-Fluoropiperidin-1-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
1-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-4-(1-methyl-3-(trifluoromethyl)-1H-pyrazol-5-yl)pyridin-2(1H)-one
6-(3,3-Difluoropiperidin-1-yl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(2-(Difluoromethoxy)phenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(2-Cyclopropoxyphenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(2-(Difluoromethyl)phenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,3-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,4-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(4-Fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((10S)-7-(2-(2-Fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-(1-methyl-1H-pyrazol-3-yl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-5-oxo-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
1-(((S)-7-((R)-2-(2,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-4-phenylpyridin-2(1H)-one
6-(3-Fluorophenyl)-3-(((S)-7-((R)-2-(3-fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(3-fluorophenyl)pyrimidin-4(3H)-one
6-Cyclopropyl-3-(((S)-7-((R)-2-(3-fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-Cyclopropyl-3-(((S)-7-((R)-2-(2,5-difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((10S)-7-(2-(3,4-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((10S)-7-(2-(3,5-difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
6-(2-Fluoro-6-methoxyphenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(2-Fluoro-6-methylphenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(3-Fluoro-2-methoxyphenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-50 azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(5-Fluoro-2-methoxyphenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
6-(2,3-Difluorophenyl)-3-(((S)-10-hydroxy-7-((R)-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(m-tolyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-fluorophenyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-2-(2,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-methoxyphenyl)pyrimidin-4(3H)-one
6-(3-Azabicyclo[3.1.0]hexan-3-yl)-3-(((S)-7-((R)-2-(2,5-difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyrimidin-4(3H)-one
3-(((S)-10-Hydroxy-7-((R)-2-methyl-2-phenylpiperazine-1-carbonyl)-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
4-(2-Fluorophenyl)-1-(((S)-7-((R)-2-(3-fluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)pyridin-2(1H)-one
3-(((S)-7-((R)-2-(3,5-Difluorophenyl)piperazine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-(2-fluorophenyl)pyrimidin-4(3H)-one
3-(((S)-7-((R)-3-(2,5-Difluorophenyl)thiomorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((R)-3-(2,5-Difluorophenyl)-1,1-dioxidothiomorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((10S)-7-((3R)-3-(2,5-Difluorophenyl)-1-imino-1-oxido-1λ6-thiomorpholine-4-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((2S,4S)-4-Amino-2-phenylpiperidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
3-(((S)-7-((2S,4R)-4-Amino-2-phenylpiperidine-1-carbonyl)-10-hydroxy-7-azaspiro[4.5]decan-10-yl)methyl)-6-phenylpyrimidin-4(3H)-one
or a stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt thereof.

### Claim 46 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-45 that is an inhibitor of USP19, preferably human USP19.

### Claim 47 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46)

A pharmaceutical composition comprising a compound according to any one of claims 1-46 or a stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt thereof, and a pharmaceutically acceptable carrier or diluent.

### Claim 48 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47 for use in therapy.

### Claim 49 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47 for use in treating muscular atrophy.

### Claim 50 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47 for use in treating obesity.

### Claim 51 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47 for use in treating insulin resistance.

### Claim 52 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47 for use in treating type II diabetes.

### Claim 53 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A method of treating obesity comprising administering to a subject in need thereof an effective amount of a compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47.

### Claim 54 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A method of treating insulin resistance comprising administering to a subject in need thereof an effective amount of a compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47.

### Claim 55 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A method of treating type II diabetes comprising administering to a subject in need thereof an effective amount of a compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47.

### Claim 56 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A method of treating muscular atrophy comprising administering to a subject in need thereof an effective amount of a compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47.

### Claim 57 (depends on 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47)

A method of reducing loss of muscle mass in a subject comprising administering to a subject in need thereof an effective amount of a compound, stereoisomer, tautomer, hydrate, N-oxide derivative or pharmaceutically acceptable salt according to any one of claims 1-46 or a pharmaceutical composition according to claim 47.

### Claim 58

A USP19 inhibitor for use in treating obesity.

### Claim 59

A USP19 inhibitor for use in treating muscular atrophy.

### Claim 60

A USP19 inhibitor for use in treating type II diabetes.

### Claim 61

A USP19 inhibitor for use in treating insulin resistance.

### Claim 62

A USP19 inhibitor for use in treating cancer.

### Claim 63

A method of treating cancer, obesity, insulin resistance, type II diabetes and/or muscular atrophy comprising administering to a subject in need thereof an effective amount of a USP19 inhibitor.