TAK-071 / Mechanism

Mechanism

rowtext
molecule / classa M1 muscarinic ACh receptor positive allosteric modulator (PAM).
TAK-071 selectivityTAK-071 specifically activates post-synaptic neurons, with no effect on M4 or other ACh receptors
comparator / noteC?) AChEIs increase synaptic ACh longevity. Activation of presynaptic M4 receptors then reduces synaptic ACh release.

TAK-071 PD Falls and cognition Timelines – Base Plan

TAK-071 PD Falls and cognition timeline

2019, 2020, 2021, 2022, 2023, 2024, 2025, 2026, 2027, 2028, 2029
groupactivitydates / milestones
Follow-up to PRCFollow-up to PRCPRC-PRC Memo; LDE; Ph 3 studies are placeholders; Phase3 study; markers around 10 Jul28 and 13 Jun29
Clinical StudiesPD Gait ePoC30 Nov20 - 22 Feb23
Clinical StudiesPD Ph2 Dose ranging/Ph3 Studies (2)30 Jul24 - 31 May28
Clinical StudiesPD Long Term Safety29 Jan25 - 22 Nov29
Clinical StudiesDDI (2) Studies for CYP3A414 Sep22 - 09 May23
Clinical StudiesIND/NDA Submission/ApprovalIND; Remove Partial CH; EOP2/EMA-HTA
Clinical StudieshADME Study14 Apr23 - 09 Feb24
CMCCTM for ePOC01 Oct18 - 31 May20
CMCDS/DP development for Ph3*30 Aug22 - 31 Aug23
CMCAPI & CTM for Ph3 (pilot scale)*30 Aug22 - 25 Jul24
CMCCTM for Ph3 (2nd supply)01 Jul24 - 03 Apr25
CMCDS/DP registration stability01 Jul24 - 29 Oct27
Toxicology26W Rat30 Aug22 - 09 Aug23
Toxicology39W NHP30 Aug22 - 12 Oct23
ToxicologyDefinitive EFDs30 Aug22 - 25 Feb23
ToxicologyMale/female Fertility30 Aug22 - 27 Mar23
ToxicologyTG car study + DRF-SPA28 Mar23 - 29 May25
Toxicology2 year rat car study29 Jul24 - 27 Nov27
*Raw material ordering and some DS/DP development begin in 2021. Initiating 6 month prior (Jan 2022) will be additional 0.8 OY.
*hADME, Asian bridging, tQT studies will be conducted after successful ePOC. LDE 1 month after DDI studies.
"Reg team is exploring fast track, and Ph3 digital tools

Timeline of TAK-071

TM of TAK-071

(20201211 TAK-071 CDP_NSRB_11Dec2020.docx) Potential IIR or Takeda-sponsored biomarker study: Currently, there is no biomarker for the TAK-071 program, and none is used in the 2002 study. The team has interacted extensively with Dr. Lewis Lipsitz, Chair of Gerontology at Beth Israel Hospital whose research program is focused on falls in cognitively impaired elderly patients. His group has identified resting state fMRI imaging correlates of gait variability in elderly subjects. Resting state EEG or fMRI could be a useful biomarker to explore dose-response relationships in this regard to improve the choice of doses to test in the Ph2b study. A IIR or Takeda-sponsored study can be considered if study 2002 is positive.

cGAS (cyclic GMP-AMP synthase, cGAMP synthase, =mb21d1)

MOA cGAS

Normal / Pathophysiology

steptext
cell questionWhich cell? {Chin, 2019 #765 더보지}
Korean note적어도 이 구간은 모든 cell (말초포함, 비신경세포포함)에서 보이겠는데?
triggerdeficient in Prkn or Pink1
cytosol / mitophagycytosol; mitophagy; mtDNA released into the cytosol
cGAS DNA bindingCgas binds to cytosolic DNA, in a sequence-independent manner
cGAS activationCgas is activated via conformational change in the active site
cGAMP synthesiscGAS synthesizes cGAMP (=cyclic GMP-AMP) from ATP and GTP (돌아다니는 둘을 합쳐서)
STING activationcGAMP binds and activates STING (=tmem173)
kinase activationSTING activates (kinases) IKK & TBK1
transcription factorsIKK & TBK1 activate (TF) NF-kB & IRF3 (via phosphorylation)
nucleusNF-kB and IRF3 enter the nucleus
gene expressionActivation of expression of (IFN) response genes in the nucleus
downstream effects↑ type I Interferons (ie a product of STING activation); ↑ microglia recruitment; ↑ apoptosis; neurodegeneration
{Matsui, 2021 #1541} 그런데 (cGAS말고도) 다른 NUCLEIC ACID sensor molecule많다: IFI16, DDX41, TLR9, AIM2, DHX9, ZBP1, MRE11, DHX36, (즉 cGas억제해도 이런 것들이 보상적으로 오르면 어쩔?)

Evidence

row / contexttext
Loss of LRRK2↑ DRP1 phosphorylation
Evidence / Human / postmortem{Matsui, 2021 #1541} Fig5b, sPD medulla oblongata에서 ↑ (cytosolic) ds mt DNA (postmortem)
Niigata planPostmortem brain sample from Niigata univ: IHC of cGAS results in FY21 4q; Niigata univ: Will not look at cGAMP & STING
cGAS / cGAMP questionscGAS protein?; cGAMP level?
serum / patient{Borsche, 2020 #1044} patient에서 오르긴 했으나 overlap
Korean interpretation제일 가능성 높은 군에서 이러니 mtDNA를 sPD에서의 stratification BM으로 쓰기는 난망
Borsche cohort note{Borsche, 2020 #1044} - German cohort: n=15 Parkin-PD 와 Pink1-PD 섞인 (각 구성 UNKNOWN) - Italian cohort: n=19 Parkin-PD 와 Pink1-PD 섞인 (각 구성 UNKNOWN)

Borsche 2020 IL6 / PRKN / PINK1 Figure

Borsche 2020 PRKN/PINK1 IL6 figure fragment

- Total 34명: 중 parkin 23명, PINK1 11명, h&y 2.6, disease duration 18.1 y, age 51.3
 
Analysing PRKN and PINK1 mutation carriers separately, we did not detect any difference between IL6 levels, neither in biallelic nor in heterozygous mutation carriers (Supplementary Fig. 2). This was true for both the German (Supplementary Fig. 2A and C) and the Italian cohorts (Supplementary Fig. 2B and D).

Uncertain Spans

locationtext/statusreason
page labelPage 44 of 50Apple Vision and PaddleOCR agree for this statusbar, but adjacent synthesized pages previously showed Page 34 of 40; keep exact OCR-visible value pending manual check.
nav pathTAK-071 > MechanismInferred from body heading and nav entries. The page also includes Timeline of TAK-071, TM of TAK-071, and the start of cGAS > MOA cGAS, so the active highlight should be manually confirmed.
TAK-071 mechanism comparatorC?) AChEIs...Row label is partly cut/unclear; the mechanism sentence is readable but the leading marker is uncertain.
timeline titlePD Falls and cognition Timelines - Base PlanThe right edge of the title is visible, but the left/center title is slightly blurred.
timeline row labelsPD Gait ePoC, TG car study + DRF-SPA, DS/DP registration stabilitySmall text; OCR engines disagree slightly on capitalization/spelling.
timeline datesall activity date rangesMany dates are small; copied only when legible in both image/OCR evidence.
footnote0.8 OY, tQT, fast track, Ph3 digital toolsSmall text at the bottom of the timeline; preserve visible wording pending review.
TM paragraphA IIR, study 2002, Dr. Lewis LipsitzText is readable but line-wrapped and partly near the right photo edge.
cGAS title=mb21d1Visible as typed, but gene symbol may require normalization before KB use.
cGAS pathwaySTING (=tmem173), NF-kB, IRF3, DRP1 phosphorylationVisually readable but narrow columns make OCR fragile.
Borsche cohort noteGerman/Italian cohort compositionPhoto cuts the right side slightly; Parkin-PD/Pink1-PD mixed cohort text should be checked.